An Unexpected Encounter With Chicago Nato Protestors

Two years after lawmakers unsuccessfully tried to enlarge the state budget by creating a privately run bail bonds system in Wisconsin, the controversial idea could be returning.

The field of mental health will face its greatest upset in years on Saturday with the publication of the long-awaited and deeply-controversial US manual for diagnosing mental disorders. Early drafts of the book, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, have divided medical opinion so firmly that authors of previous editions are among the most prominent critics. Known informally as the psychiatrists’ bible, the $199 tome from the American Psychiatric Association is the guidebook that US doctors will use to diagnose mental disorders. The latest edition is the first major update in 20 years. Though not used in the UK, where doctors turn to the World Health Organisation’s International Statistical Classification of Diseases (ICD), the US manual has global influence. It defines groups of patients, and introduces new names for disorders. Those names can spread, and become the norm elsewhere. More importantly, the categories redefine the populations that are targeted by drugs companies. Criticisms have come from almost every corner. There are claims of expansionism, with common experiences and behaviours becoming newly medicalised. Temper tantrums become disruptive mood dysregulation disorder (DMDD); grief becomes major depressive disorder (MDD), according to Allen Frances, an American psychiatrist who chaired the task force behind the fourth edition of the manual. Other behaviours get their own labels: overeating becomes binge eating disorder; keeping too much junk, a hoarding disorder; a bit forgetful could be mild neurocognitive disorder. David Clark, professor of experimental psychology at Oxford University, said mental health disorders are often hard to divide into clear categories, because too little is known about them, and there can be major overlaps. But the definitions are often valuable. For example, greater distinctions between various types of anxiety have led to more specific and effective treatments, he said. Nick Craddock, professor of psychiatry at Cardiff University, and director of the National Centre for Mental Health in Wales, said some of the stranger aspects of the US manual will have no impact in Britain. But he said DSM-5 was flawed because definitions of disorders were sometimes changed on the basis of too little fresh scientific evidence. “I don’t believe the science has advanced sufficiently in 20 years since DSM-4 to warrant making a new system,” he said. “That essentially is just a group of people agreeing on tweaking things and making them a little bit different. That to me is not a very helpful stage in the develop of psychiatric diagnosis. This is the wrong time in history to change the diagnostic system. ” Changing the definitions of disorders alters who has them. That affects who gets drugs and other support, and who interventions are trialled on. If the criteria for attention deficit hyperactivity disorder (ADHD) are broadened, then more people are likely to be diagnosed with the condition. The arrival of DSM-5 will mark the end of Asperger’s syndrome in the US. Along with some other autism-related conditions, Asperger’s will now be consumed by the new category of “autism spectrum disorder”. Some people diagnosed with Asperger’s are unhappy about the coming change. Carol Povey, director of the National Autistic Society‘s Centre for Autism, said: “The term Asperger Syndrome is a core part of their identity for many people and they understandably feel anxious about moves to remove the term. The changes won’t prevent people from continuing to use it to define themselves and nor should it,” she said. Debbie Tucker, chair of the Asperger’s Syndrome Foundation, said the label can be useful in treating people, but that some did not want to be labelled. “Labels only become unhelpful and sometimes dangerous if used to discriminate. People with Aspergers are vulnerable to this,” she said. Last month, Thomas Insel, director of the National Institute of Mental Health, declared that the organisation would not use DSM-5 definitions to set its research priorities. Writing about DSM-5 on his blog, he said: “The weakness is its lack of validity. Unlike our definitions of ischaemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.” Instead, he said the NIHM would lay the foundations for a new classification system, based on brain imaging, genetics, cognitive science and other research. “We need to begin collecting the genetic, imaging, physiologic, and cognitive data to see how all the data – not just the symptoms – cluster and how these clusters relate to treatment response,” he said. guardian.co.uk © Guardian News and Media 2013 – – [Human brain image via Shutterstock]

Winning. Former Secretary of Defense Donald Rumsfeld has published a new book. It's a book of advice. You too can get advice from The Man Who Screwed Up The War. You can give it as a gift to someone you want to catastrophically fail at life. Fine, let's take a look. Marketplace highlights three of "Rumsfeld's Rules": It’s easier to get into something than it is to get out. “I thought of that when I was President Reagan’s Middle East envoy and we had 241 Marines killed at Beirut, at the airport. And I concluded then that the United States has to be careful about putting ground forces in because we’re such a big target. And I also over the years came to the conclusion over the years that the United States really was organized, trained and equipped to do nation-building.” Those are two odd lessons to put together. Luckily, he forgot the first just in time to personally disprove the second. “I’ve been mistaken so many times I don’t even blush for it anymore.” – Napoleon “You see things that don’t turn out the way you hoped.” Oh my God. What is this, life lessons for fifth graders? Sometimes you goof up, kids. Sometimes you have to send a few thousand "sorry for your dead child" Hallmark cards when you goof up. Best you can hope for is that you get a motivational book out of it someday. Monitor progress through metrics. “I think that history over time will probably be a better judge than you or I, but I’ve been struck by the amount of criticism that the Bush administration has received and President Bush personally and the attempts to assign blame to him and I think it’s probably not going to sort out that way.” Monitor progress through metrics, but if the metrics say you're a goddamn screw-up, tell people they're wrong and that they need to wait until new metrics appear that will make you look better. Repeat as necessary, possibly forever. Yeah, we're done here.

Lorraine Barnes suffered a heart attack in 2005 and has lived with the consequences – extreme exhaustion and breathlessness – ever since. “I was separated from my husband and so my children, Charlotte and James, had to grow up overnight because suddenly they were caring for me,” she says. Charlotte agrees: “It turns your world upside down. I worry about my mum day and night, 24/7.” Heart failure leaves Barnes, 49, “drowning and gasping for air”, she says. What really preys on her mind, though, is not her present difficulty but her future. “It scares me, as obviously I want to be around to see my children grow up.” There is no cure for heart failure, the aftermath of a heart attack, and the condition is common. Every seven minutes a person has a heart attack in the UK, and some victims are left so weakened they can hardly walk a few metres. It’s a grim scenario. But the prospects for patients like Barnes last week took a dramatic turn for the better when it was revealed that human cloning has been used for the first time to create embryonic stem cells from which new tissue – genetically identical to a patient’s own cells – could be grown. Scientists have been working on such techniques (see box) for some time but their work has been hampered by the difficulties involved in cloning human cells in the laboratory. But the team led by Shoukhrat Mitalipov, of the Oregon Health and Science University in Portland, got around this problem. By adding caffeine to cell cultures, their outputs were transformed. “We were able to produce one embryonic stem cell line using just two human eggs, which would make this approach practical for widespread therapeutic use,” said Mitalipov. The development was hailed as a major boost for patients such as Barnes, who might benefit from tissue transplants – and not just heart attack patients but those suffering from diabetes, Parkinson’s disease and other conditions. But the announcement was also greeted with horror. “Scientists have finally delivered the baby that would-be human cloners have been waiting for: a method for reliably creating cloned human embryos,” said David King of Human Genetics Alert. “It is imperative we create an international ban on human cloning before any more research like this takes place. It is irresponsible in the extreme to have published this.” Several tabloid newspapers also carried banner headlines warning of the human cloning “danger”. Such reactions have a familiar ring. When the cloning of Dolly the Sheep was revealed in 1997 there was an outpouring of hysteria about the prospect of multiple Saddam Husseins being created in laboratories. “At the time the chances of these horrors occurring – when scientists had not even created a single clone of a human cell – were remote,” said physiologist Professor Colin Blakemore of Oxford University. “Not that this worried the alarmists. The crucial point is that we should have spent the intervening time thinking about how we should react sensibly to the concept of a human clone when it does become possible. We have not done that and, although the science is still far off, it is getting closer. We need to ask, carefully and calmly: under what circumstances would we tolerate the creation of a human clone?” At present such a creation is banned in Britain. No human embryo created by cloning techniques is allowed to develop beyond 14 days. “The research is very tightly regulated and I think there is little chance of a rogue laboratory creating a human clone,” said James Lawford Davies, a lawyer who specialises in health sciences. “However, many US states which, ironically, banned therapeutic cloning work because of their strong anti-abortion stances have laws that would permit human clones to develop into foetuses.” Experts such as Professor John Harris, director of Manchester University’s Institute for Science, Ethics and Innovation, see positive benefits in reproductive cloning which could have a place in society. He said: “If you take a healthy adult’s DNA and use it to create a new person – by cloning – you are essentially using a tried and tested genome, one that has worked well for several decades for the donor. By contrast, a child born naturally has an 8% chance of succumbing to a serious genetic abnormality because of the random selection of their DNA. You can avoid that with a clone.” In fact, most arguments against human cloning are foolish, said Harris, adding: “It could be used in medically helpful ways. If a couple find they are carriers of harmful, possibly fatal recessive genetic illnesses, there is a one in four chance they will produce a child who will die of that condition. That is a big risk. An alternative would be to clone one of the parents. If you did that, then you would know you were producing a child who would be unaffected by that illness in later life. “Or consider the example of a single woman who wants a child. She prefers the idea of using all her own DNA to the idea of accepting 50% from a stranger. But because we ban human cloning she would be forced to accept DNA from a stranger and have to mother ‘his child’. I think that is ethically questionable. Just after Dolly the Sheep was born, Unesco announced a ban on human cloning. I think that was a mistake.” This point was backed by Blakemore. He said: “Many people react with horror at the thought of a human clone, yet three out of every 1,000 babies born today are clones – in the form of identical twins. These twins share not just the same DNA but have grown up in the same uterus and have had the same parenting – features that only intensify their similarities. Society is quite happy about this situation, it appears, but seems to find it odd when talking about cloning.” However, a note of caution was sounded by Ian Wilmut, who led the team that created Dolly the Sheep. He said: “The new work may encourage some people to attempt human reproductive cloning but the general experience is that it still results in late foetal loss and the birth of abnormal offspring.” It would be cruel to cause this in humans until techniques had been vastly improved, he added. However, most scientists see Mitalipov’s work as encouraging. If nothing else, the prospects for Lorraine Barnes – and countless other patients whose lives could be transformed by transplants – have greatly improved in the long term. How it works The nucleus is removed from a human egg cell and the nucleus from a skin cell is inserted. An electric shock fuses the skin cell nucleus inside the egg and it begins to divide into new cells. An embryo starts to form. After a few days the growth of the embryo is halted and cultures of its constituent stem cells created. By treating stem cells with different chemicals they can be transformed into specialised cells such as those that make up heart muscle, brain, pancreas and other organs. These cells are genetically identical to the original skin cell and can be used to create tissue for transplanting into the skin cell’s donor . www.bhf.org.uk guardian.co.uk © Guardian News and Media 2013 – – [Scientist doing lab research via Shutterstock]

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