• Iraq and the UN Security Council: the ICC?
• the International Criminal Court…
• the crime of aggression…

^{After the Rome Statute reached the requisite 60 ratifications in 2002, President George W. Bush’s Administration sent a note to the UN Secretary General on May 6, 2002. The note suspended the signature of the US and informed the Secretary General that the US recognized no obligation toward the Rome Statute. In addition, the US stated that its intention not to be become a member state be reflected in the UN depositry’s list. This is because signatories have an obligation not to undermine the object and purpose of a treaty. The US could engage with the Court by reactivating its signature to the Rome Statute by a letter to the UN Secretary General. A treaty that is not ratified is not legally binding.}

What was going on in that summer of 2002? Well, we regular Americans were driving around with magnetic American Flags on our cars, still reeling from 9/11. Behind closed doors, the Bybee/Yoo torture memos were framed and signed. Abu Zubaydah and Ibn al-Shaykh al-Libi were in custody and being tortured. Bush had introduced the "Bush Doctrine" in his West Point Commencement Address. The WHIG group was about to be formed to advertise the coming invasion of Iraq. According to the Downing Street Memo, our war plans were set and we were going to skip the UN. So Bush’s withdrawing from the World Court [ICC] was a harbinger of things to come.

Below, I’ve reproduced just the first two pages of this State Department summary of the world’s reaction. It’s followed by a country by country summary - scathing! This about sums it up, "The universal bone of contention was that Washington is ‘undermining’ international principles pertaining to human rights, peacekeeping and the rule of law that the U.S. itself was instrumental in establishing." "Consequently, the U.S. refusal to recognize the ICC’s authority was seen as an attempt to help Israel escape prosecution for its ‘war crimes’ in Palestine and for the U.S. to avoid its own ‘war crimes’ in Afghanistan and those it ‘plans to commit in Iraq.’" Read it knowing this is your country they’re talking about. We were not fooling anybody…

I said, "We are not a people like the Germans are a people with a homogeneous  ethnic heritage. Only our principles and our history bind us" … and that’s been a hard road. We had a disasterous Civil War over racial differences in our first century. A hundred years later, the country was gripped with another civil conflict we now call the Civil Rights Movement. At an earlier time, we said "Give me your tired, your poor, Your huddled masses yearning to breathe free, The wretched refuse of your teeming shore." Now we’re building border fences and talking about immigration reform. We’re a heterogeneous lot in a big place. All we have in common are a few good documents from our founding and a short history [234 years].

During the last Administration, we sustained the first real attack on our soil. We rallied around the flag like at no other time in my lifetime. And then our own government betrayed us. In secret, it plotted a war of aggression. In secret, it tapped our citizens’ phones. In secret, it tortured prisoners of war. In secret, the Department of Justice became part of a political apparatus. In quiet, it deconstructed our Civil Rights Institutions. It lied outright to start a war. It lied to the UN, then ignored it. The Administration, besides being secret was divisively partisan. And the slogans of patriotism were used to cover a government that was much more like a Monarchy than a Democracy.

Those few good documents were tarnished, at times beyond recognition. The covenant of our founders was not honored. Our history was betrayed with duplicity, direct lies, and omissions.  All of those forces that bind us were besmirched. The people on the conservative side were inflamed about the liberals. The liberals were disdained and the butt of contempt. One nation under God became Two nations - one under a specific version of God, another under seige. We are divided now in a different way than ever before, suffused with hatred. The net product of the Bush years was to fragment us into warring tribes. I personally believe a lot of that was done on purpose.

OPELOUSAS, La. — At 18 months, Kyle Warren started taking a daily antipsychotic drug on the orders of a pediatrician trying to quell the boy’s severe temper tantrums. Kyle Warren at 6 years old. At 18 months, Kyle started taking a daily antipsychotic drug on the orders of a pediatrician trying to quell the boy’s severe temper tantrums. Thus began a troubled toddler’s journey from one doctor to another, from one diagnosis to another, involving even more drugs. Autism, bipolar disorder, hyperactivity, insomnia, oppositional defiant disorder. The boy’s daily pill regimen multiplied: the antipsychotic Risperdal, the antidepressant Prozac, two sleeping medicines and one for attention-deficit disorder. All by the time he was 3.

He was sedated, drooling and overweight from the side effects of the antipsychotic medicine. Although his mother, Brandy Warren, had been at her “wit’s end” when she resorted to the drug treatment, she began to worry about Kyle’s altered personality. “All I had was a medicated little boy,” Ms. Warren said. “I didn’t have my son. It’s like, you’d look into his eyes and you would just see just blankness.”

Today, 6-year-old Kyle is in his fourth week of first grade, scoring high marks on his first tests. He is rambunctious and much thinner. Weaned off the drugs through a program affiliated with Tulane University that is aimed at helping low-income families whose children have mental health problems, Kyle now laughs easily and teases his family. Ms. Warren and Kyle’s new doctors point to his remarkable progress — and a more common diagnosis for children of attention-deficit hyperactivity disorder — as proof that he should have never been prescribed such powerful drugs in the first place…

More than 500,000 children and adolescents in America are now taking antipsychotic drugs, according to a September 2009 report by the Food and Drug Administration. Their use is growing not only among older teenagers, when schizophrenia is believed to emerge, but also among tens of thousands of preschoolers. A Columbia University study recently found a doubling of the rate of prescribing antipsychotic drugs for privately insured 2- to 5-year-olds from 2000 to 2007. Only 40 percent of them had received a proper mental health assessment, violating practice standards from the American Academy of Child and Adolescent Psychiatry.

“There are too many children getting on too many of these drugs too soon,” Dr. Mark Olfson, professor of clinical psychiatry and lead researcher in the government-financed study, said. Such radical treatments are indeed needed, some doctors and experts say, to help young children with severe problems stay safe and in school or day care. In 2006, the F.D.A. did approve treating children as young as 5 with Risperdal if they had autistic disorder and aggressive behavior, self-injury tendencies, tantrums or severe mood swings. Two other drugs, Seroquel from AstraZeneca and Abilify from Bristol-Myers Squibb, are permitted for youths 10 or older with bipolar disorder.

But many doctors say prescribing them for younger and younger children may pose grave risks to development of both their fast-growing brains and their bodies. Doctors can legally prescribe them for off-label use, including in preschoolers, even though research has not shown them to be safe or effective for children. Boys are far more likely to be medicated than girls…

Dr. Ben Vitiello, chief of child and adolescent treatment and preventive research at the National Institute of Mental Health, says conditions in young children are extremely difficult to diagnose properly because of their emotional variability. “This is a recent phenomenon, in large part driven by the misperception that these agents are safe and well tolerated,” he said. Even the most reluctant prescribers encounter a marketing juggernaut that has made antipsychotics the nation’s top-selling class of drugs by revenue, $14.6 billion last year, with prominent promotions aimed at treating children. In the waiting room of Kyle’s original child psychiatrist, children played with Legos stamped with the word Risperdal, made by Johnson & Johnson. It has since lost its patent on the drug and stopped handing out the toys. Greg Panico, a company spokesman, said the Legos were not intended for children to play with — only as a promotional item.

It’s great that these articles are beginning to appear frequently. Physicians and Patients alike have been sold a bill of goods about these medications. The fact that antipsychotic medications are the Pharmaceutical Industry’s biggest sellers [$14.6 billion!] is beyond absurd - bordering over into criminal. It’s certainly not because psychosis is that prevalent - it’s not. It’s because the industry has successfully hyped the medications for other conditions with the unfortunately common help of physicians [often academic physicians] paid as key opinion leaders. As long as I’m on this topic, get those ads off of the television sets. "Ask your doctor if _____ is right for you." They don’t belong there. They are part of this problem.

Former British prime minister Tony Blair spends more than 100 pages of his newly released memoir defending the war in Iraq. Blair, who was criticized for his decision to stand by President George W. Bush and send British troops to the region, covers the topic throughout three chapters of his book, “A Journey: My Political Life”…

In discussing the buildup to the war, Blair reminds the reader of the fear that was felt throughout the world after the September 11th attacks. He said he doesn’t know why the intelligence on Saddam Hussein’s weapons of mass destruction was wrong, but maintains Saddam may have been able to develop such weapons in the future if action had not been taken against him. “I still believe that leaving Saddam in power was a bigger risk to our security than removing him, and that terrible though the aftermath was, the reality of Saddam and his sons in charge of Iraq would at least arguably be much worse,” he wrote.

Blair dismisses speculation that Iraq’s oil had a role in the decision to go to war, stating that, “if oil had been our concern, we would have cut a deal with Saddam in a heartbeat.” He defends Bush at several points in the memoir and gives the former president credit for the 2007 troop surge in Iraq — something Obama didn’t do in his Oval Office address.

Is no one sorry? Blair says, "his task is ‘not to persuade the reader of the rightness of the cause, but merely to persuade that such a cause can be made out.’" What does that mean? It’s possible that one can make an argument that this wasn’t the biggest blunder of all time, in spite of overwhelming evidence to the contrary? "… he never guessed at the ‘nightmare that unfolded’ after the invasion."  Which nightmare is he referring to? The fact that every reason given for the invasion was a lie, and that that was apparent early in the war? Or was it the nightmare that al Qaeda [that had attacked the U.S. because we were occupying the Middle East] reacted negatively to our further occupation of the Middle East? Could he be referring to the fact that Iraq which had a bad government and had been choked by the embargoes didn’t do well with no government at all? Maybe the nightmare was Cheney ["He believed, in essence, that the U.S. was genuinely at war; that the war was one with terrorists and rogue states that supported them. … In other words, he thought the world had to be made anew…"]. Now there’s a nightmare I can get with.

Speaking of Cheney, Blair says, "Dick is the object of so much conspiracy theory that it’s virtually impossible to have a rational discussion on him. My take on him was different from that of most people. I thought he had one central insight which was at least worth taking seriously. He believed, in essence, that the U.S. was genuinely at war; that the war was one with terrorists and rogue states that supported them." There’s another piece of Blair logic, it’s at least possible that what Cheney thought should be taken seriously [unlike everything else that Cheney thought?]. Just because Cheney had a single thought that should be taken seriously doesn’t mean we had to act on that thought. We were at war with the Terrorists. We were at war with the rogue states that supported them. Iraq just didn’t happen to be one of those rogue states that supported them. I knew that back then. Most of us did, and the ones that didn’t just weren’t thinking right. Tony Blair probably knew it himself.

But he goes on to say, "I still believe that leaving Saddam in power was a bigger risk to our security than removing him, and that terrible though the aftermath was, the reality of Saddam and his sons in charge of Iraq would at least arguably be much worse" [there's that word again "arguably" with a modifier - "at least"]. I think Blair actually believed that. Maybe Bush and Cheney did too. I personally think they were wrong, but that’s just a disagreement. Bush said the same thing Blair’s now saying. "You’ve got to understand," Bush said. "Saddam Hussein was a bad man." No one has ever argued with Hussein’s badness. But that’s not why Congress, or America, or Britain agreed to invade Iraq. "I still believe that leaving Saddam in power was a bigger risk to our security than removing him" was simply not true. Our security was not at risk from Iraq, whether Hussein stayed in power or was deposed - either way. I am not persuaded "that such a cause can be made out." It’s not true now. It wasn’t true then.

There was no Casus Belli [cause for war]. Lord Goldsmith said it to Blair over and over again. In this country, we shamefully knew that to be true but didn’t act on it. Maybe we had temporary insanity because of 911. Most of the evidence says otherwise - that the plans to depose Hussein antedated 911. Maybe Blair had temporary insanity too, but we don’t need a book from him trying to justify his acting crazy. All that does is make his insanity a permanent fixture.

^{Mission accomplished? The Iraq war did more than anything to alienate the Atlantic powers from the rest of the world today the Iraq war was declared over by Barack Obama. As his troops return home, Iraqis are marginally freer than in 2003, and considerably less secure. Two million remain abroad as refugees from seven years of anarchy, with another 2 million internally displaced. Ironically, almost all Iraqi Christians have had to flee. Under western rule, production of oil – Iraq’s staple product – is still below its pre-invasion level, and homes enjoy fewer hours of electricity. This is dreadful.}

^{Some 100,000 civilians are estimated to have lost their lives from occupation-related violence. The country has no stable government, minimal reconstruction, and daily deaths and kidnappings. Endemic corruption is fuelled by unaudited aid. Increasing Islamist rule leaves most women less, not more, liberated. All this is the result of a mind-boggling $751bn of US expenditure, surely the worst value for money in the history of modern diplomacy.}

^{Most failed "liberal" interventions since the second world war at least started with good intentions. Vietnam was to defend a non-communist nation against Chinese expansionism. Lebanon was to protect a pluralist country from a grasping neighbour. Somalia was to repair a failed state. In Iraq the casus belli was a lie, perpetrated by George Bush and his meek amanuensis, Tony Blair. Saddam Hussein was accused of association with 9/11, and of plotting further attacks with long-range weapons of "mass destruction". Since this was revealed as untrue, the fallback deployed by apologists for Bush and Blair is that Saddam was a bad man and so toppling him was good.}

^{The proper way to assess any war is not some crude "before and after" statistic, but to conjecture the consequence of it not taking place. Anti-Iraq hysteria began in 1998 with Bill Clinton’s Operation Desert Fox, a three-day bombing of Iraq’s military and civilian infrastructure, to punish Saddam for inhibiting UN weapons inspectors. To most of the world, it was to deflect attention from Clinton’s Lewinsky affair. Most independent analysis believed that Iraq had ceased any serious nuclear ambitions at the end of the first Iraq war in 1991, a view confirmed by investigators since 2003. Even so, Desert Fox was claimed to have "successfully degraded Iraq’s ability to manufacture and use weapons of mass destruction". Whether or not this was true, there was no evidence that such an ability had recovered by 2003. Among other things, the Iraq affair was an intelligence debacle.}

^{Meanwhile, the west’s sanctions made Iraq a siege economy, eradicating its middle class and elevating Saddam to sixth richest ruler in the world, though he faced regular plots against his person. Western hostility may have shored him up, but opposition would have eventually delivered a coup, from the army or Shia militants backed by Iran. Even had that not happened soon, Iraq was a nasty but stable secular state that no longer posed a serious threat even to its neighbours. It was contained by a no-fly zone that had rendered the oppressed Kurds de facto autonomy. It was not appreciably worse than Assad’s Ba’athist Syria, and its oil production and energy supplies were improving, not deteriorating as now…}

Obama’s Mission Accomplished Ends War of Lies:
Bloomberg
By Margaret Carlson
Sep 1, 2010

^{We were warned there would be no ticker-tape parade, no soldiers kissing nurses in Times Square, no spoils of war. What we got was a president so somber and worn, it looked as if he needed a good rest, even though he just got back from one. No amount of rest could have made it more palatable to announce the end of what began as shock and awe, but then turned shockingly awful. More than 4,400 American lives lost in Iraq so far, more than $700 billion spent, and what do we have to show for it?}

^{Yes, Saddam Hussein and his murderous sons are gone, Iraqis have held up fingers stained purple to indicate they’ve voted, and there’s a hospital here, a school there. But we didn’t leave behind a functioning government. Barack Obama’s Oval Office address Tuesday evening prompted American television networks to air daylong retrospectives on the war. It remains painful to watch snippets of bravado from George W. Bush and Dick Cheney as they insisted, contrary to reports from arms inspectors on the ground, that our choices were an invasion of Iraq or mushroom clouds caused by Iraq.}

^{One piece of video starred a leader with an icy soul. At a formal Washington dinner in March 2004 - by which time some 600 Americans had died in Operation Iraqi Freedom - a jocular, tuxedo-clad Bush narrated a slide show that must have had sides splitting during rehearsals at the White House. He cracked up his audience - including, shamefully enough, members of the television and radio news organizations that hosted the event - with pictures of himself searching the Oval Office for weapons of mass destruction. “Those weapons of mass destruction have got to be somewhere,” he drolly remarked. “Nope, no weapons over there. Maybe under here?” That’s about as funny as remembering the credible reports that the Bush team was intent on invading Iraq even before the 9/11 attacks that made us all so fearful of terrorists getting their hands on biological, chemical and nuclear weapons.}

^{Republicans were up in arms that Obama kissed off Bush’s role with a brief, nothing-burger mention - “no one can doubt President Bush’s support for our troops or his love of country,” he said - and didn’t give him credit for the surge of American troops in 2007. But there would have been no surge had there been no decision to go to war in the first place. You don’t get credit for improvements made necessary by catastrophes you create…}

^{It took Obama to end Bush’s war. It’s difficult to imagine the conditions under which Bush would have called it a day. War blinds presidents. If you doubt that, go see the brilliant documentary, “The Tillman Story.” The film takes us back to the heady days for Bush when Pat Tillman, a talented and hard-charging National Football League defender, traded in his football uniform and enlisted in the U.S. Army after the 9/11 attacks. He became an Army Ranger and fought in Iraq, then in Afghanistan. It was in Afghanistan in April 2004 that Tillman was gunned down in a hail of bullets, by his own comrades, in a raid gone horribly wrong.}

^{That awful end didn’t fit the rosy propaganda the Bush administration was peddling, so from General Stanley McChrystal on down to the grunts who burned Tillman’s uniform and other evidence, a fantasy was crafted, one that didn’t include the grim reality of friendly fire. The administration blithely assumed Tillman’s family would meekly, perhaps gratefully, stand for a horrible series of official lies. They didn’t. Friendly fire is an inevitable problem in war. Lying about it isn’t. What the Tillman story tells us is that modern war is uglier still, the same old mistakes compounded by a big spin machine to cover up the messes, Ivy League posts for retired generals and no parades for the grunts.}

^{When you start a war with such a big lie, the others you’re tempted to tell seem smaller and get easier.}

I don’t know exactly what to say about the Iraq War myself anymore. Last week, we were in Upstate New York and visited West Point and the F.D.R. Presidential Museum. Surrounding the Academy Parade field were statues of Washington, Eisenhower, MacArthur, and Patton. The FDR Museum had a reconstruction of FDR’s Map Room in the basement of the White House. I couldn’t feel the kind of patriotic emotions I usually feel at such sites. Those statues at West Point were there to hear Bush give a 2002 commencement address where he introduced his Bush Doctrine - preemptive, unilateral military action as the sole superpower actively promoting democracy in other countries.  My thoughts at those statues were discolored by intrusive thoughts of Bush clowning around or Rolling Stone’s version of General McChrystal. At West Point, there’s a memorial to the graduates who fought in the Civil War surrounded by cannons buried muzzle down. It felt sad - but not about the Civil War - about the Iraq War. Earlier, we’d visited John Brown’s farm in Lake Placid - the same sadness.

The first article says, "Most failed ‘liberal’ interventions since the second world war at least started with good intentions. Vietnam was to defend a non-communist nation against Chinese expansionism…" That’s an excellent point. As much as I opposed the Viet Nam War, I didn’t feel like this about it. Even though I personally opposed the Iraq War from the start, I still feel ashamed. It’s like we became another country, laughed off what was best about us. We were the bullies. We were the ones with the greed. We were the ones that made up lies to disguise our less than honorable motives. We treated the UN and the rest of the world with contempt and sarcasm.

António Egas Moniz [1874-1955]

^{… at a 1935 neurology conference in London that Egas Moniz attended, he noted the data presented by Jacobsen and Fulton showing that a leukotomy on two chimpanzees successfully reduced their aggressive behavior without untoward side effects. Learning of this likely prompted Moniz’s bold step to attempt the process, and in 1936, he published his first report of performing a prefrontal leukotomy on a human patient. Moniz refined his surgical methods by fashioning a "leucotome", a surgical instrument with a movable wire loop which he replaced with a steel band. He used this instrument to cut six holes in each of the brain’s two hemisphere’s white matter, severing the connections of the prefrontal cortex to the rest of the brain. Moriz judged the results acceptable in the first 40 or so patients he treated. However, he conceded that patients who had already deteriorated from the mental illness did not benefit much from the operation. Moniz concluded the following, "Prefrontal leukotomy is a simple operation, always safe, which may prove to be an effective surgical treatment in certain cases of mental disorder."Moniz did no long term follow up, and his evaluations of the success of the procedure were short term only. He believed deeply that the benefits of surgical lesions in the frontal lobes, even if some behavioral and personality deterioration occurred, were needed to treat the debilitating effects of severe mental illness. He was the first to write a scientific report of lobotomy as a psychosurgical treatment for severe mental disorders in 1936.}

^{In 1939, Moniz was shot by a disaffected patient and as a result was confined to a wheelchair for the rest of his life. In 1949 he received the Nobel Prize, "for his discovery of the therapeutic value of leucotomy in certain psychoses."  This procedure consists of cutting the connections to and from the prefrontal cortex, the anterior part of the frontal lobes of the brain. The procedure immediately became popular, as at that time there was not an effective treatment for psychosis… Soon Dr. Walter Freeman developed a version of the procedure [the transorbital lobotomy] which was much easier to carry out. Due in part to this procedural ease, lobotomy was often prescribed injudiciously and without regard for modern medical ethics. Endorsed by such influential publications as The New England Journal of Medicine, lobotomy became so popular that, in the three years immediately following Moniz’s receipt of the Prize, some 5,000 lobotomies were performed in the United States alone, and many more throughout the world. Even Joseph Kennedy, father of U.S. President John F. Kennedy, had his daughter Rosemary lobotomized when she was in her twenties. Freeman performed at least 4,000 lobotomy operations during his career. Since the 1950s, this procedure has fallen into disrepute and is even prohibited in many countries.}

Ugo Cerletti [1877-1963]

^{Convulsive therapy was introduced in 1934 by Hungarian neuropsychiatrist Ladislas J. Meduna who, believing mistakenly that schizophrenia and epilepsy were antagonistic disorders, induced seizures with first camphor and then metrazol (cardiazol). Within three years metrazol convulsive therapy was being used worldwide.  In 1937, the first international meeting on convulsive therapy was held in Switzerland by the Swiss psychiatrist Muller. The proceedings were published in the American Journal of Psychiatry and, within three years, cardiazol convulsive therapy was being used worldwide.  Italian Professor of neuropsychiatry Ugo Cerletti, who had been using electric shocks to produce seizures in animal experiments, and his colleague Lucio Bini developed the idea of using electricity as a substitute for metrazol in convulsive therapy and, in 1937, experimented for the first time on a person. Sherwin B. Nuland, having discussed the matter with a first-hand observer in the 1970s, gave the following description of the results of the first use of ECT on a person:}

^{"They thought, ‘Well, we’ll try 55 volts, two-tenths of a second. That’s not going to do anything terrible to him.’ So they did that. [...] This fellow — remember, he wasn’t even put to sleep — after this major grand mal convulsion, sat right up, looked at these three fellows and said, ‘What the fuck are you assholes trying to do?’ Well, they were happy as could be, because he hadn’t said a rational word in the weeks of observation."}

^{ECT soon replaced metrazol therapy all over the world because it was cheaper, less frightening and more convenient.  Cerletti and Bini were nominated for a Nobel Prize but did not receive one. By 1940, the procedure was introduced to both England and the US. Through the 1940s and 1950s the use of ECT became widespread. ECT is the only form of shock treatment still performed by modern medicine.}

Manfred Sakel [1900-1957]

^{Insulin shock therapy or insulin coma therapy was a form of psychiatric treatment in which patients were repeatedly injected with large doses of insulin in order to produce daily comas over several weeks. It was introduced in 1933 by Polish-Austrian-American psychiatrist Manfred Sakel and used extensively in the 1940s and 1950s, mainly for schizophrenia, before falling out of favour and being replaced by neuroleptic drugs. Insulin coma therapy and the convulsive therapies were collectively known as shock therapy. Although insulin coma therapy had disappeared in the USA by the 1970s, it was still being used at that time in some countries such as China, and the former Soviet Union.}

^{In 1927 Sakel, who had recently qualified as a doctor in Vienna and was working in a psychiatric clinic in Berlin, began to use low [sub-coma] doses of insulin to treat drug addicts and psychopaths. Having returned to Vienna, he treated schizophrenic patients with larger doses of insulin in order to produce coma and sometimes convulsions. Sakel made public his results in 1933 and his methods were soon taken up by other psychiatrists. Joseph Wortis, after seeing Sakel practice it in 1935, introduced it to the USA. British psychiatrists from the Board of Control visited Vienna in 1935 and 1936, and by 1938 thirty-one hospitals in England and Wales had insulin treatment units. In 1936 Sakel moved to New York and also introduced insulin coma treatment into American psychiatric hospitals. By the late 1940s the majority of psychiatric hospitals in the USA were using insulin coma treatment.}

Thorazine

^{In 1933, the French pharmaceutical company Laboratoires Rhône-Poulenc began to search for new anti-histamines. In 1947, it synthesized promethazine, a phenothiazine derivative, which was found to have more pronounced sedative and antihistaminic effects than earlier drugs… The chemist Paul Charpentier produced a series of compounds and selected the one with the least peripheral activity, known as RP4560 or chlorpromazine, on 11 December 1950. Simone Courvoisier conducted behavioural tests and found chlorpromazine produced indifference to aversive stimuli in rats. Chlorpromazine was distributed for testing to physicians between April and August 1951. Laborit trialled the medicine on at the Val-de-Grâce military hospital in Paris, using it as an anaesthetic booster in intravenous doses of 50 to 100 mg on surgery patients.and confirming it as the best drug to date in calming and reducing shock, with patients reporting improved well being afterwards…}

^{Following on, Laborit considered whether chlorpromazine may have a role in managing patients with severe burns, Reynaud’s Syndrome, or psychiatric disorders. At the Villejuif Mental Hospital in November 1951, he and Montassut administered an intravenous dose to psychiatrist Cornelio Quarti who was acting as a volunteer. Quarti noted the indifference, but fainted upon getting up to go to the toilet, and so further testing was discontinued. Despite this, Laborit continued to push for testing in psychiatric patients during early 1952. Psychiatrists were reluctant initially, but on January 19 1952, it was administered [alongside pethidine, penthothal and ECT] to Jacques Lh. a 24 year old manic patient, who responded dramatically, and was discharged after three weeks having received 855 mg of the drug in total.}

^{Pierre Deniker had heard about Laborit’s work from his brother in law, who was a surgeon, and ordered chlorpromazine for a clinical trial at the Hôpital Sainte-Anne in Paris where he was Men’s Service Chief. Together with the Director of the hospital, Professor Jean Delay, they published first clinical trial in 1952, in which they treated 38 psychotic patients with daily injections of chlorpromazine without the use of other sedating agents. The response was dramatic; treatment with chlorpromazine went beyond simple sedation with patients showing improvements in thinking and emotional behaviour. They also found that doses higher than those used by Laborit were required, giving patients 75-100 mg daily.}

^{Deniker then visited America, where the publication of their work alerted the American psychiatric community that the new treatment might represent a real breakthrough. Heinz Lehmann of the Verdun Protestant Hospital in Montreal trialled it in 70 patients and also noted its striking effects, with patients’ symptoms resolving after many years of unrelenting psychosis. By 1954, chlorpromazine was being used in the United States to treat schizophrenia, mania, psychomotor excitement, and other psychotic disorders… The effect of this drug in emptying psychiatric hospitals has been compared to that of penicillin and infectious diseases. But the popularity of the drug fell from the late 1960s as newer drugs came on the scene. From chlorpromazine a number of other similar antipsychotics were developed…}

It’s easy to criticize a treatment for its failures. I’ve been critical of the newer atypical antipsychotics. But that criticism is not for the effort. The drugs were developed in an attempt to avoid some of the more difficult and sometimes permanent neurological side effects of the earlier neuroleptics, and they have generally moved towards that goal. The criticism is instead directed towards the minimization by the manufacturers of the unique toxicities of these drugs and overblowing their effectiveness. Even worse, the invasion of clinical medicine by market driven [often downright corrupt] strategies and the attempts to extend the use of these drugs inappropriately is a genuine tragedy for medical science.

Today, in one of my volunteer jobs, I saw a 17 year old boy who I’ve seen for several months. The boy had been quietly psychotic, mostly staying in his room for several years ["he's always been shy and quiet"]. In spite of constant attacking auditory hallucinations, paranoid feelings, and uncanny mystical ideas, he’d continued high school and graduated with his psychosis largely un-noticed. I initially tried an "atypical" [Resperidol] hoping to avoid side effects, but his symptoms persisted in spite of increasing the dose. I started him on an older drug [Haldol] and at 2mg/day, his symptoms abated. Predictably, today he and his father came to discuss a frightening dystonic reaction, so we spent our time talking about how to manage his EPS if it happened again.

President Obama is promoting the decision to end the U.S. combat mission in Iraq on Tuesday as a fulfillment of his campaign promise to draw the war to a close. But some of the president’s detractors are using the same moment to question the wisdom of doing so - noting that Iraq is still afflicted with violence and has yet to form a government. Obama will mark the occasion by flying to Fort Bliss, Tex., to meet with veterans. He will also deliver a prime-time Oval Office speech - only his second since taking office. On Monday, the president visited Walter Reed Army Medical Center and awarded 11 Purple Hearts to combat veterans. Vice President Biden traveled to Iraq to amplify the message.

"Maybe he’s entitled to the partial victory lap, but this is not the right moment for it," said analyst Michael O’Hanlon of the Brookings Institution, who has been critical of both Democratic and Republican approaches to the war. "If I were him, I’d wait until we have an Iraqi government, and do it with the Iraqis together." O’Hanlon said he was "confused about the planned Oval Office speech." It could raise unrealistic expectations among the public about the chances for calm in Iraq, he said. And the timing of the pullout of combat troops may be seen as having more to do with the president’s political needs than with real signs of progress on the ground.

White House officials said the speech, scheduled to begin at 8 p.m. and last 15 to 20 minutes, would acknowledge this week’s deadline as a "milestone" and pay tribute to the 1.5 million Americans who have served in Iraq since 2003. Obama will address shifting U.S. options now that the country is no longer technically at war in Iraq, including a greater emphasis on Afghanistan and Pakistan - and the domestic economy.

Obama will say that "it’s time for Iraq to step up and take responsibility for security in the country," one senior administration official said, and that "it’s time to rebalance our resources when it comes to national security and our economy." Obama will call former president George W. Bush before the speech, White House press secretary Robert Gibbs said. He did not say whether Obama will give his predecessor credit for the 2007 troop "surge" as Republicans have demanded.

The interesting thing: was Iraq a danger in 2003? They were not a danger. They were practically prostrate and could not - it would have taken a lot of time to reconstitute in selling oil. What they got instead was a long period of anarchy. I think one conclusion I am inclined to draw is that anarchy can be worse than tyranny.

How many years have we heard things like "the timing of the pullout of combat troops may be seen as having more to do with the president’s political needs than with real signs of progress on the ground"?  Or plans to train the Iraqi Army or Police? Or attempts to negotiate with the warring factions in Iraq? There’s nothing right to do, and there has never been anything right to do from the day President Bush announced his "shock and awe" bombing of Baghdad had commenced. John Boehner is saying that Bush should get credit for "the Surge" allowing us to pull out of Iraq. But if there’s continued violence [which is almost assured] they’ll say we pulled out too soon [like they've said for years]. Obama has no choice to make. No matter what he does, it will be wrong - because the war was wrong from the start. It would probably be wrong for him to even say that the war was wrong. It would be equally wrong to say the war was right. He’s in the position he’s been in with most of his big decisions, to make the most correct wrong choice. And leaving Iraq no matter what happens is the right wrong choice to make in this instance. It’s the fate of following the failed Presidency of George W. Bush and Richard Cheney for him to spend his time in office trying to clean up the carnage that preceded him with the very people who participated in that carnage yapping constantly at his heels. Rather than mark our ceasing combat in Iraq with bickering and political divisiveness, we ought to declare a day of mourning for the senseless waste of the Iraq War in every possible dimension. A day of shame, not blame…

Questions loom over drug given to sleepless vets
Associated Press
By MATTHEW PERRONE
08/31/2010

^{WASHINGTON — Andrew White returned from a nine-month tour in Iraq beset with signs of post-traumatic stress disorder: insomnia, nightmares, constant restlessness. Doctors tried to ease his symptoms using three psychiatric drugs, including a potent anti-psychotic called Seroquel. Thousands of soldiers suffering from PTSD have received the same medication over the last nine years, helping to make Seroquel one of the Veteran Affairs Department’s top drug expenditures and the No. 5 best-selling drug in the nation. Several soldiers and veterans have died while taking the pills, raising concerns among some military families that the government is not being up front about the drug’s risks. They want Congress to investigate…}

^{It’s unclear how many soldiers have died while taking Seroquel, or if the drug definitely contributed to the deaths. White has confirmed at least a half-dozen deaths among soldiers on Seroquel, and he believes there may be many others. Spending for Seroquel by the government’s military medical systems has increased more than sevenfold since the start of the war in Afghanistan in 2001, according to documents obtained by The Associated Press under the Freedom of Information Act. That by far outpaces the growth in personnel who have gone through the system in that time…}

^{But the drug’s potential side effects, including diabetes, weight gain and uncontrollable muscle spasms, have resulted in thousands of lawsuits. While on Seroquel, White gained 40 pounds and experienced slurred speech, disorientation and tremors — all known side effects…}

^{The VA’s spending on Seroquel has increased more than 770 percent since 2001. In that same time frame, the number of patients covered by the VA increased just 34 percent. Seroquel has been the VA’s second-biggest prescription drug expenditure since 2007, behind the blood-thinner Plavix. The agency spent $125.4 million last fiscal year on Seroquel, up from $14.4 million in 2001. Spending on Seroquel by the Department of Defense, has increased nearly 700 percent since 2001, to $8.6 million last year, according to purchase records…}

^{The only published study on use of Seroquel for PTSD-related insomnia involved just 20 patients who were followed for six weeks at a VA medical center in South Carolina. The study, which showed moderate improvement in sleep, was funded by AstraZeneca at the request of VA psychiatrist Dr. Mark Hamner, who has studied the use of Seroquel for PTSD. In his written conclusion, published in 2003, Hamner urged caution in interpreting the results because of the study’s small size and short duration…}

^{The drug, approved in 1997, is AstraZeneca’s second-best-selling product, with U.S. sales of $4.2 billion last year. But that success has been marred by allegations that the company illegally marketed the drug and minimized its risks. AstraZeneca agreed to pay $520 million in April to settle federal allegations that its salespeople pitched Seroquel for numerous off-label uses, including insomnia. Pharmaceutical companies are prohibited from marketing drugs for unapproved uses. AstraZeneca also faces an estimated 10,000 product liability lawsuits, most alleging that Seroquel caused diabetes…}

AstraZeneca Pays $198M To Settle US Seroquel Claims
Wall Street Journal
By Simon Zekaria
August 9, 2010

^{LONDON (Dow Jones)–U.K. pharmaceutical group AstraZeneca PLC (AZN.LN) said Monday it has reached a $198 million settlement over claims regarding its best-selling antipsychotic drug Seroquel in the U.S. AstraZeneca has faced thousands of product-liability lawsuits alleging that the use of Seroquel caused diabetes and other injuries, and that the company failed to adequately warn of the drug’s risks. The group has also faced long-running allegations it improperly promoted the drug, which is approved to treat schizophrenia, bipolar disorder and depression.}

^{The settlement relates to 17,500 product liability claims, and the company said the mediation process over claims is ongoing in both federal and state jurisdictions. "We remain committed to a strong defense effort, but will also continue to participate in good faith in court-ordered mediation," the company said in a statement.}

^{Federal prosecutors and authorities from several U.S. states have been probing allegations AstraZeneca promoted Seroquel off-label, or for uses not approved by the U.S. Food and Drug Administration. In April, the company announced a settlement of $520 million with the U.S. Justice Department over the matter. Astrazeneca Monday said that, as of June 29, approximately 2,900 additional claims had been dismissed by order or agreement.}

^{In March, the company said it would not appeal a preliminary ruling by a British regulatory panel, the Prescription Medicines Code of Practice Authority, that found the drug maker failed to accurately reflect side-effects of Seroquel in an advertisement to doctors, published in 2004. AstraZeneca reported global Seroquel sales of $4.9 billion last year, and drug-data tracker IMS Health ranked it as the fifth best-selling drug in the world. At 0759 GMT, AstraZeneca shares rose 25 pence, or 0.8%, to 3280 pence, valuing the company at GBP47.64 billion.}

^{Analysts said the settlement figure is small. "If you look at the settlement (value) per patient, it is very low compared to what is typical for this industry," Matrix Corporate Capital analyst Navid Malik said. Malik also said it is difficult for patients to prove liability, which is positive news for the stock. Shore Capital analysts said that "while there may be additional outstanding liability claims in other geographies … the agreement in principle today confirms the limited nature of any financial exposure." The company said its core earnings per share guidance for 2010 remains unchanged at a range of $6.35 to $6.65. AstraZeneca posted global revenues of $32.8 billion in 2009.}

• There is no real reason for Seroquel to be on the market at all that I can see. It is primarily an atypical antipsychotic drug introduced for the treatment of Schizophrenia. It is less effective than the drugs it was purported to replace in that condition. In many ways, it is more toxic than the drugs it was supposed to replace. It’s other uses are either fabricated or simply because it is anxiotytic. We have more than enough anxiolytic drugs.It has no real niche.
• Besides being no more effective than the alternatives, it is much more expensive. This is no time for us to be driving up the cost of medicine.
• For any psychiatric drug, particularly this one, to be "the fifth best-selling drug in the world" is absolutely absurd. If people don’t like how life feels and we’re going to go along with that, legalize marijuana - it’s safer and a lot cheaper.
• By any report, AstraZeneca is near the top for bogus stunts in marketing, and that’s saying a lot in light of the overall corruption in the psycho-pharmaceutical industry [see this particularly clear summary of stunts].

Early life influences risk for psychiatric disorders

"Early Life Programming and Neurodevelopmental Disorders" by Tracy L. Bale, Tallie Z. Baram, Alan S. Brown, Jill M. Goldstein, Thomas R. Insel, Margaret M. McCarthy, Charles B. Nemeroff, Teresa M. Reyes, Richard B. Simerly, Ezra S. Susser, and Eric J. Nestler. Biological Psychiatry, Volume 68, Issue 4 [August 15, 2010]…

^{For more than a century, clinical investigators have focused on early life as a source of adult psychopathology. Although the hypothesized mechanisms have evolved, a central notion remains: early life is a period of unique sensitivity during which experience confers enduring effects. Neurodevelopmental disorders, which include mood disorders, schizophrenia, autism and eating disorders, have been associated with fetal antecedents such as maternal stress or infection and malnutrition. Sex is another factor that influences the risk for psychiatric disorders through poorly understood mechanisms.}

^{We know little as to how the maternal environment alters offspring programming. Epigenetics, an area of research that is studying how environmental factors produce lasting changes in gene expression without altering DNA sequence, may provide new insights into this question. A new review, published in Biological Psychiatry, has "incorporated the latest insight gained from clinical and epidemiological studies with potential epigenetic mechanisms from basic research," explained first author Dr. Tracy Bale. These key findings are from a conference on Early Life Programming and Neurodevelopmental Disorders held at the University of Pennsylvania.}

^{For example, the authors discuss findings where maternal stress has been associated with an increased risk of schizophrenia in male offspring and may alter fetal brain growth. Data also indicate that maternal stress, infection, and/or exposure to famine contribute to an elevated risk for depression in offspring. Of critical importance, the brain continues to develop into adolescence, and so later influences, such as exposure to child abuse and/or neglect, must also be taken into account. Studies have consistently shown that adults who experience maltreatment as children are at a much greater risk of developing mood disorders.}

^{Clearly, multiple factors are at play that influence an individual’s disease risk. By applying the principals of personalized medication, one can view this science as "personalized prevention," as it aims to apply these principals earlier in the pathological process. Understanding and defining these disease mechanisms at the very earliest points in life could help identify novel targets in therapy and prevention.}

But there’s something else to say about this abstract. It’s based on the observation fact that people who have a bad time of things in early life are prone to misery as adults. There’s not much news there. Authors have written about that for centuries. Psychoanalysts, learning theorists, psychotherapists of all ilks have talked about how a dismal childhood leads to an unquiet mind [the operative word here is mind, not brain]. People [like me] have spent whole careers talking to unhappy people trying to help them sort out how their previous experience in life has discolored their adult perceptions and emotions. Were we deluded? Were we talking to people about the wrong things when we should really have been looking at their epigenetic something or another, selecting some appropriate chemical intervention based on their genome? I personally kind of doubt it, but my bias is obvious.

Back to the abstract. There are a number of assumptions that deserve our skepticism. In the world of Charles Nemeroff, sadness and unhappiness are elements of a mood disorder. And in his world, a mood disorder has a biological basis. In a few cases, that’s probably true. It’s called Manic Depressive Illness [bipolar disorder]. But in modern times that possibility has been magnified astronomically. While we don’t have a solid biological marker to discriminate those patients, we do have some reliable clinical criteria for identifying them. Very few of the people I see meet those criteria, yet in a modern world, one hears "I have a chemical imbalance" or "I’m bipolar" from patients all the time, even here in the back woods of Georgia. To say it’s an oversold idea doesn’t do justice to the ubiquity of this idea.

In the world of Charles Nemeroff, negative experience in childhood causes adult unhappiness via some as yet undefined genetic/epigenetic mechanism rather than by influencing the developing mind. In fact, he never mentions the mind. Never mind, always brain seems to be his mantra. Further, in the world of Charles Nemeroff, "personalized medicine" means picking the right treatment [drug] based on the patient’s personal endowment [genetics]. I’ll leave you to evaluate the studies he bases this assertion on but I’m beyond unimpressed. It’s an idea that he and his colleagues find exciting. I’d be excited too if there were some evidence for it.

But there’s yet another point to make. If we made the unlikely assumption that everything in this abstract were to turn out to be ultimately true in some hypothetical future time - unhappiness = depression = mood disorder = biological = mediated through some epigenetic/genetic mechanism = treatable by some "personalized" drug - Charles Nemeroff is not going to be the person who discovers that pathway. Nemeroff is a break-through freak. He’s spent his career trying to find some spectacular piece of biology that will immortalize him for all times [and pay for his lavish lifestyle]. He’s chased corticotrophin releasing factor, vagus nerve stimulation, lithium patches, abortion drugs  in depression [Mifepristone eg RU-486], almost any psychoactive drug [particular ones whose makers pay him], etc. etc. looking for a break-through to put him on the map. He’s not a careful scientist who follows a line of inquiry and knows a dead end when he sees it. He has made a career of looking for the silver bullet, ever ready to jump on any speculation that might lead him to find the pot of gold at the end of the rainbow. And worse, his ethics are universally questionable. He’s apparently able to spin anything into an exciting break-through, a Glenn Beck with a white coat, an Oz behind a curtain. He stepped down as an editor when he published a review touting his own fantasied break-throughs based on - well actually who knows what it was based on. He was fired as Chairman at Emory after repeated ethical violations [that he lied about for years]. He has danced between ethically challenged and just plain crook throughout his career. This is not the kind of person that makes scientific discoveries. If there’s a scientist who has made a genuine contribution to our body of scientific knowledge with a story like Nemeroff’s, I’ve never heard of him/her.

While the point was a yearly week-long reunion with friends from the early 70’s Air Force days, as long as we were in the area, why not see what Upstate New York was about?  It was a trip worth mentioning. We flew to Albany [yellow arrow] and drove to Lake Placid [1] where the six couples had rented a house on the lake. There are plenty of sites around that area - the lake itself with more old wooden Chris Craft motorboats than I imagined existed and the remains of two Winter Olympics [1932 and 1980], now an Olympic Training Center. That week, we did take a trip back south [2] to the Saratoga Battlefield and "the races" at Saratoga Springs. The Battle of Saratoga was a really big deal in the Revolutionary War. General Burgoyne marched his British Army down the Hudson from Canada planning to connect their forces in Canada with their Army in the New York Harbor. His defeat [Generals Horatio Gates and Benedict Arnold] not only kept the Revolution alive but impressed the French who then sided with us. I’m not usually big on battlefield parks, but this one was a ten.

After our friends left, we drove north to the Saint Lawrence Seaway through the Adirondacks Mountains/Park [which is huge, covering 20% of New York State]. Other than a few villages and Amish Carriages selling baked goods, it’s wilderness. Our first destination was the Fredric Remington Museum in Ogdensburg [3]. It was much more than advertised. Besides the wealth of sketches and a full collection of his bronze  statuettes, there were a number of his oil paintings, personal memorobilia, and demonstrations of bronze casting. We spent the night in Alexandria Bay, a resort town on the seaway [wherein was being held the New York Firemen's Convention - some scene]. We had supper down the road in Clayton NY [4] at the hotel restaurant where Thousand Island Dressing was invented - a real treat. Clayton also has the Antique Boat Museum which we visited the next day before driving to Rochester [5] to the Eastman Museum [through driving rain]. After a night in Rochester [at the Hyatt Hotel where the Second Annual International ROC City Tattoo Expo was in full sway - living art everywhere], we drove on to Niagara Falls, which was just as you imagined it [only bigger].

Thus far, our drive had been from destination to destination, but then it changed. From Buffalo through the Catskills [6-11], it was about the spaces in-between the places. There were certainly sites along the way - the Wind Farm in Wyoming County [7], Millard Filmore’s favorite restaurant in East Aurora, the remarkable Corning Glass Museum [8], the best ice cream parlor in America in Watkins Glenn [9], and, of course, the Baseball Hall of Fame in Cooperstown [10]. But the main attraction was the byways through that beautiful countryside. It was mostly farmland with old Federal style houses, big barns, silos everywhere, fields of corn [for silage], cows, and towns and villages that could have been 50 years ago [a hundred years ago in places], except for the cars and an occasional convenience store. Simple and refreshing. If they didn’t have winter, I’d move there in a heartbeat. Who knew? Such a surprise after years of travel to New York City. Oh yeah, the people were delightful too - friendly and happy.

The Hudson River Valley was another grand surprise. The Military Academy at West Point [11] is a must-visit. American Gothic architecture with manicured fields, filled with history. My favorite story was that Douglas MacArthur’s mother checked into a hotel on post when she took her son to college, and stayed in that same hotel room for the whole four years he was there - watching through binoculars to see if he was up too late. No wonder he wanted to return to the Philippines! I’m not a military sort, but I was impressed with West Point. It has grand views of the Hudson River which is much bigger than I imagined. It seemed wider than the Mississippi in places [though much calmer]. We followed the Hudson south and crossed at Tarrytown.

While there are many estates to visit, the best site in Tarrytown [12] is Sunnyside, the home of author Washington Irving on the bank of the river. We bought and read The Legend of Sleepy Hollow, then visited the Tarrytown/Sleepy Hollow cemetery which has his grave, the Old Dutch Church, and the bridge from the story where the headless horseman threw his pumpkin head at Ichabod Crane. That graveyard also had the Rockefellers, Chrysler, Carnegie, Gompers, Leona Helmsley, Elizabeth Arden, and a gajillion other notorati. Up the road, there was a small church [Union Church of Pocantico Hills] with nine spectacular Marc Chagall stained glass windows [and one by Matisse designed two days before he died]. Lots of history [and money] there in Tarrytown.

^{That night, the Johnny Depp movie "Sleepy Hollow" was on the old console tv in our motel room. It wasn’t the greatest flick ever made, but I watched it all the way through, since fate had chosen for it to be shown the very day we went to Sleepy Hollow.}

Moving north up the Hudson, one arrives in Hyde Park [13] home of FDR and his Presidential Library. It follows his life from beginning to end. To me, the most interesting part was a reconstruction of his "Map Room" in the White House basement from which he directed WWII. A code machine, typewriter, telephone, world maps on the wall, a desk, and a few chairs. A tiny command center for the biggest war of all. Like MacArthur, FDR’s mom was always around - living with FDR and Eleanor until he died [or maybe vice versa]. The other treats in Hyde Park were Eleanor’s post FDR home [Val-kill], lunch at the Culinary Institute of America, and a small Park on the Hudson [maybe the best of all].