Psychiatry's civil war

How DSM-V is written will ultimately affect patients

Editorial: Psychiatry's bible: Its time has passed

Since this article was first posted, the American Psychiatric Association has announced that the publication of DSM-V will be delayed until May 2013. "Extending the timeline will allow more time for public review, field trials and revisions," says APA president Alan Schatzberg.

When doctors disagree with each other, they usually couch their criticisms in careful, measured language. In the past few months, however, open conflict has broken out among the upper echelons of US psychiatry. The focus of discord is a volume called the Diagnostic and Statistical Manual of Mental Disorders, or DSM, which psychiatrists turn to when diagnosing the distressed individuals who turn up at their offices seeking help. Regularly referred to as the profession's bible, the DSM is in the midst of a major rewrite, and feelings are running high.

Two eminent retired psychiatrists are warning that the revision process is fatally flawed. They say the new manual, to be known as DSM-V, will extend definitions of mental illnesses so broadly that tens of millions of people will be given unnecessary and risky drugs. Leaders of the American Psychiatric Association (APA), which publishes the manual, have shot back, accusing the pair of being motivated by their own financial interests - a charge they deny. The row is set to come to a head next month when the proposed changes will be published online. For a profession that exists to soothe human troubles, it's incendiary stuff.

Psychiatry suffers in comparison with other areas of medicine, as diseases of the mind are on the whole less well understood than those of the body. We have, as yet, only glimpses into the fundamental causes of the common mental illnesses, and there are no biological tests to diagnose them. This means conditions such as depression, schizophrenia and personality disorders remain difficult to diagnose with precision. Doctors can only question people about their state of mind and observe their behaviour, classifying illness according to the most obvious symptoms.

We have only glimpses into the causes of mental illnesses and there are no biological tests for them

First published in 1952, the DSM has its origins in a book used by the US military to determine if recruits were mentally fit for combat. The difficulty of separating mental disorders from normal variation in behaviour made it controversial from the start. Over the years, the book's influence has grown, and today it is used by doctors across the globe.

The wording used in the DSM has a significance that goes far beyond questions of semantics. The diagnoses it enshrines affect what treatments people receive, and whether health insurers will fund them. They can also exacerbate social stigmas and may even be used to deem an individual such a grave danger to society that they are locked up.

Some of the most acrimonious arguments stem from worries about the pharmaceutical industry's influence over psychiatry. This has led to the spotlight being turned on the financial ties of those in charge of revising the manual, and has made any diagnostic changes that could expand the use of drugs especially controversial. "I think the DSM represents a lightning rod for all kinds of groups," says David Kupfer of the University of Pittsburgh, Pennsylvania, who heads the task force appointed by the APA to produce the revised manual.

Few would claim that the DSM's current version is perfect. With each revision, the number of conditions it defines has swelled, many surrounded by bewildering lists of symptoms that must be checked to assign a diagnosis. Using current DSM checklists, for example, 114 different combinations of symptoms can lead to a diagnosis of schizophrenia. At the same time, many patients prove hard to fit into the framework.

One aim of the work groups compiling DSM-V is to cut through this chaos. They are streamlining diagnoses by removing various subtypes of schizophrenia, for example, and intend to address the confusion created by the fact that many people with one condition meet criteria for other disorders as well. The DSM-V task force is expected to propose a series of "dimensions" to be considered with a patient's main diagnosis. So as well as deciding whether someone has, say, bipolar disorder, doctors would determine whether they are suffering from problems such as anxiety and sleeping disturbances, and assess them on a simple scale of severity.

Grandiose claims

This is widely seen as a first step towards a future in which psychiatric diagnosis has a more scientific base, where sprawling checklists of symptoms are replaced by sliding-scale measurements of the underlying determinants of mental health. Yet critics worry that even a limited embrace of this "dimensional" approach is running ahead of the science. Until we understand more about the biological basis of psychiatric disease, this approach will not be helpful, they say.

Some of the harshest criticisms have come from those who led previous revisions of the DSM, in 1980 and 1994. In July, Robert Spitzer and Allen Frances, both now retired, wrote a stinging letter to the APA, accusing it of planning unworkable changes and making grandiose claims. In a separate editorial in the magazine Psychiatric Times, Frances complained that most of the authors are university-based researchers who are cut off from typical doctors and patients.

Spitzer and Frances also criticise the fact that members of the various DSM-V work groups have had to sign confidentiality agreements. "The main problem is that we don't know what they're doing," says Spitzer. The APA says the confidentiality agreements are to stop the manual's authors writing their own diagnostic handbooks alongside the official manual. Kupfer points out that discussion does go on: work groups proposing major changes debate their ideas in papers and at meetings. "We've done everything we can to encourage it," he says.

Another focus for Spitzer and Frances's concern is the suggestion that DSM-V could include new categories to capture milder forms of illnesses such as schizophrenia, depression and dementia. "The result would be a wholesale... medicalization of normality that will lead to a deluge of unneeded medication," Frances said in his editorial.

For example, one work group is considering whether it is possible to catch people in the early stages of schizophrenia or other psychotic illnesses before they have their first full-blown psychotic episode (Schizophrenia Bulletin, vol 35, p 841). Some doctors prescribe antipsychotic drugs at this early stage in the hope of stopping the illness from progressing.

Libido loss

These medicines can have serious side effects, such as loss of libido, weight gain and distressing tremors and spasms, so no one would want to take them without good reason. Yet it's hard to separate distressed people who will go on to develop a psychotic disorder from the "false positives" - those who will recover or develop a different illness. The available evidence suggests that only about 30 per cent of people identified as being at risk of psychosis will go on to develop it within two years.

These medicines can have serious side effects so no one wants to take them without good reason

Nevertheless, William Carpenter, a psychiatrist at the University of Maryland in Baltimore who chairs the DSM-V work group on psychosis, believes the needs of the "true positives" are so great that adding a diagnostic category to cover "psychosis risk" would, on balance, be a good thing. Frances brands this proposed diagnosis as "the most worrisome suggestion entertained".

Given the controversy, psychosis risk may not make it into the DSM proper, and may instead appear in the appendix, as a condition needing more research. But even that designation might boost prescribing.

Frances and Spitzer are not the only ones with concerns, and there are other flashpoints (see "Hebephilia", "Transgendered" and "Bereavement"). In March, Jane Costello of Duke University in Durham, North Carolina, resigned from the work group on disorders in childhood and adolescence, worried about what she saw as a lack of scientific rigour across the whole DSM revision. "I felt that there was not enough empirical work being achieved or planned," she says.

The disputes are getting ugly. Senior APA figures have even suggested that Spitzer and Frances are motivated by a desire to safeguard their flow of royalties from clinical guides linked to the current DSM. "The fact that Dr. Frances was informed... that subsequent editions of his DSM-IV associated products would cease when the new edition is finalized, should be considered when evaluating his critique," leading APA figures said in a response to Frances's editorial.

Spitzer and Frances reject this charge. "To suggest that I have no concern other than the royalties is a little absurd," says Spitzer. "My annual royalties from DSM-IV related books are $10,000 per year," notes Frances. "These have nothing to do with concerns I expressed."

Attention has also turned to the financial interests of those working on DSM-V. The APA has ruled that members of the task force and work groups may not receive more than $10,000 per year from industry while working on DSM-V, and must keep their stock holdings below $50,000. This doesn't satisfy Lisa Cosgrove of the University of Massachusetts, Boston, who studies financial conflicts in psychiatry (New Scientist, 29 April 2006, p 14). She notes that the APA's ruling places no limit on industry research grants, and has found that the proportion of DSM-V panel members who have industry links is exactly the same as it was for DSM-IV, at 56 per cent (The New England Journal of Medicine, vol 360, p 2035).

The final version of DSM-V is scheduled to be published in 2012, but given the level of controversy and the need to test whether psychiatrists can reliably use the proposed diagnoses, that date seems certain to slip.

For now, there is an uneasy ceasefire, but next month the work groups will post their proposed changes on the APA's website. Stand by for renewed hostilities.

Editorial: Psychiatry's bible: Its time has passed

Hebephilia

How young is too young?

You may have never heard of "hebephilia", but this obscure diagnosis has huge significance in the courts. If it becomes accepted it could lead to hundreds of sex offenders who have served their jail time being locked up indefinitely - on grounds that some say are spurious.

Hebephilia refers to when adults are sexually fixated on teenagers around the time of puberty. This sets it apart from paedophilia, which refers to a focus on pre-pubescent children. The DSM-V work group on sexual disorders is likely to call for paedophilia to be renamed paedohebephilia, and include a hebephilic subtype.

The justification is the research of one work group member, Ray Blanchard of the University of Toronto in Canada. Working with sex offenders, Blanchard used a device that records blood flow in the penis to measure their arousal while they were listening to sexual material. He concluded that some men have a disorder that causes them to fixate on girls aged 11 to 14 (Archives of Sexual Behavior, vol 38, p 335).

The proposed diagnosis has been condemned by critics as dangerously blurring the boundary between paedophilia and normal male attraction to teenage girls - which isn't necessarily acted upon. Karen Franklin, a forensic psychologist in El Cerrito, California, argues that the diagnosis makes a disease out of preferences that have been shaped through human evolution. "People didn't used to live so long and mating started earlier," she says.

The work group is also considering whether some men are specifically turned on by rape - a proposed condition termed paraphilic coercive disorder. Again, the evidence is based largely on measurements of penile blood flow in response to sexual images and stories, and the validity of the condition is hotly contested.

The rows over hebephilia and paraphilic coercive disorder aren't academic, because 20 US states have passed laws that allow sex offenders who have served their sentences to be detained indefinitely in a secure hospital if they are deemed "sexual predators" (New Scientist, 24 February 2007, p 6). This can only be done if the offenders have a psychiatric disorder that increases their risk of reoffending - which few do, according to DSM-IV.

Franklin says that if hebephilia and paraphilic coercive disorder make it into DSM-V, they will be seized upon to consign men to a lifetime of incarceration. This argument cuts little ice with Blanchard, however. "The clinical facts are what they are," he says.

Transgendered

We are who we say we are

Is history repeating itself? That's the question facing psychiatrists considering how gender identity should be defined in DSM-V. The APA has a legacy of uneasy relations with the lesbian, gay and transgender community, having included homosexuality in the DSM's list of psychiatric disorders until 1973. Some transgender activists want issues of gender identity kicked off the list of mental illnesses too.

These activists are up in arms over the membership of DSM-V's sexual and gender identity disorders work group, in particular the selection of Kenneth Zucker of the University of Toronto, Canada, as its chair. Zucker is reviled by some transgender activists for his work on therapy to reorient children who feel that they were born into the wrong sex. An online petition objecting to the work group's composition has more than 9500 signatures.

The group is nevertheless likely to recommend changes that could actually ease tensions. One of these is a change in the name of a diagnosis that as currently phrased is inherently offensive to transgender people. "'Gender identity disorder' falsely implies that the gender identities of gender variant people are in themselves disordered," says Kelley Winters, founder of GID Reform Advocates.

The work group has not yet revealed its proposed name, but "disorder" will be dropped. "We're sensitive to issues of language," says Zucker. One possibility is "gender dysphoria", which focuses on the inherent distress of people living in a body that doesn't match their identity.

That would not satisfy those transgender activists who want issues of gender identity removed from the DSM altogether. But others argue for the retention of a renamed condition to make it easier for those distressed by the mismatch between their identity and their bodies to seek assistance, and also to help those who need sex-change surgery to get it paid for. Even now, many transgender people face problems when insurers refuse to recognise the treatment as a legitimate medical expense.

Bereavement

When does grief become an illness?

Losing a loved one is the most devastating event that most people ever experience, yet the official diagnosis of depression specifically excludes people who have recently been bereaved. Now there may be a major shift.

Not only is bereavement a known trigger for depressive symptoms, but bereaved people respond just as well to antidepressant treatment as others with similar symptoms, says Jan Fawcett of the University of New Mexico, Albuquerque, who heads the DSM-V work group on mood disorders. He thinks it may be time to class people who are severely distressed due to a recent bereavement as depressed.

For most people time proves at least a partial healer. But about 10 per cent of bereaved people are still debilitated by their loss more than six months later - and they can remain locked into this loop of grief for many years. Acknowledging their plight, the proposals for DSM-V are expected to include a new diagnosis of "complicated grief" or "prolonged grief syndrome".

The impetus for this comes from a team led by Holly Prigerson of Harvard Medical School in Boston, who has shown the condition can be reliably diagnosed (PLoS Medicine, vol 6, p e1000121). Katherine Shear, now at Columbia University in New York, has also found that the condition responds well to a form of psychotherapy designed to help bereaved people begin resuming their lives (Journal of the American Medical Association, vol 293, p 2601).

New NASA Photos Show Apollo Leftovers on the Moon

NASA's Lunar Reconnaissance Orbiter, or LRO, has returned its first imagery of the Apollo moon landing sites, showing the Apollo missions' lunar module descent stages sitting on the moon's surface.


(AP) -- New NASA photos of the moon show the leftovers from man's exploration 40 years ago. For the first time, photos from space pinpoint equipment left behind from Apollo landings, and even the well-worn tracks made by astronauts on the moon surface. The images are from the Lunar Reconnaissance Orbiter, which was launched last month and now circles the moon in search of future landing sites.

The photos were released Friday, in time for the 40th anniversary of the first moon landing on July 20, 1969. A picture of the Apollo 11 site shows the Eagle lunar module used by Neil Armstrong and Buzz Aldrin.

''It was really great to see the hardware sitting on the surface, waiting for us to come back,'' said Arizona State University scientist Mark Robinson, who runs the camera on the orbiter. ''You could actually see the descent module sitting on the surface.''

But that's only if you know where to look. NASA helps out by putting a giant arrow on each photo. The lunar landers look to be square white blobs; the Eagle is a fuzzy image near a crater.

NASA landed on the moon six times, but the orbital camera so far has only photographed five of the landing sites. Apollo 12 will be done later. That leaves Apollo 11 and Apollo 14 through 17. Apollo 13 never landed on the moon because of an explosion on board the ship on the way to the moon.

The images for Apollo 14 are the best so far. Taken on Wednesday, they show the path made by astronauts Alan Shepard Jr. and Edgar Mitchell as they went back and forth from the lander to the work site.

Robinson said the route was ''a high traffic zone, sort of like when you go in an old building and the carpet is worn down.'' A similar but lighter path could be seen at the Apollo 17 site.

Also at the Apollo 14 site, a close examination shows a trail made by the cart used to carry tools, Robinson said.

The photos varied in quality based on how high up the satellite was and the angle of the sun. For Apollo 11, the spaceship was taking pictures from 70 miles above. For Apollo 14, it was six miles closer.

In the next couple months, as the lunar satellite starts its mission to map the moon for future landing sites for astronauts, it will get much better photos, Robinson said. The mission is a first step in NASA's effort to return humans to the moon by 2020.

Other robotic probes, including those launched by Japan and India, have looked for signs that man was on the moon, but their cameras weren't strong enough, NASA officials said.

The Lunar Reconnaissance Orbiter was launched with a second spacecraft that was designed to crash into the moon in the fall to try to find buried ice. The total cost of the mission is $583 million.

The Sky Is Falling

Image credit: Stéphane Guisard, www.astrosurf.com/sguisard

Breakthrough ideas have a way of seeming obvious in retro­spect, and about a decade ago, a Columbia University geophysicist named Dallas Abbott had a breakthrough idea. She had been pondering the craters left by comets and asteroids that smashed into Earth. Geologists had counted them and concluded that space strikes are rare events and had occurred mainly during the era of primordial mists. But, Abbott realized, this deduction was based on the number of craters found on land—and because 70 percent of Earth’s surface is water, wouldn’t most space objects hit the sea? So she began searching for underwater craters caused by impacts rather than by other forces, such as volcanoes. What she has found is spine-chilling: evidence that several enormous asteroids or comets have slammed into our planet quite recently, in geologic terms. If Abbott is right, then you may be here today, reading this magazine, only because by sheer chance those objects struck the ocean rather than land.



Abbott believes that a space object about 300 meters in diameter hit the Gulf of Carpentaria, north of Australia, in 536 A.D. An object that size, striking at up to 50,000 miles per hour, could release as much energy as 1,000 nuclear bombs. Debris, dust, and gases thrown into the atmosphere by the impact would have blocked sunlight, temporarily cooling the planet—and indeed, contemporaneous accounts describe dim skies, cold summers, and poor harvests in 536 and 537. “A most dread portent took place,” the Byzantine historian Procopius wrote of 536; the sun “gave forth its light without brightness.” Frost reportedly covered China in the summertime. Still, the harm was mitigated by the ocean impact. When a space object strikes land, it kicks up more dust and debris, increasing the global-cooling effect; at the same time, the combination of shock waves and extreme heating at the point of impact generates nitric and nitrous acids, producing rain as corrosive as battery acid. If the Gulf of Carpentaria object were to strike Miami today, most of the city would be leveled, and the atmospheric effects could trigger crop failures around the world.

What’s more, the Gulf of Carpentaria object was a skipping stone compared with an object that Abbott thinks whammed into the Indian Ocean near Madagascar some 4,800 years ago, or about 2,800 B.C. Researchers generally assume that a space object a kilometer or more across would cause significant global harm: widespread destruction, severe acid rain, and dust storms that would darken the world’s skies for decades. The object that hit the Indian Ocean was three to five kilometers across, Abbott believes, and caused a tsunami in the Pacific 600 feet high—many times higher than the 2004 tsunami that struck Southeast Asia. Ancient texts such as Genesis and the Epic of Gilgamesh support her conjecture, describing an unspeakable planetary flood in roughly the same time period. If the Indian Ocean object were to hit the sea now, many of the world’s coastal cities could be flattened. If it were to hit land, much of a continent would be leveled; years of winter and mass starvation would ensue.

At the start of her research, which has sparked much debate among specialists, Abbott reasoned that if colossal asteroids or comets strike the sea with about the same frequency as they strike land, then given the number of known land craters, perhaps 100 large impact craters might lie beneath the oceans. In less than a decade of searching, she and a few colleagues have already found what appear to be 14 large underwater impact sites. That they’ve found so many so rapidly is hardly reassuring.

Other scientists are making equally unsettling discoveries. Only in the past few decades have astronomers begun to search the nearby skies for objects such as asteroids and comets (for convenience, let’s call them “space rocks”). What they are finding suggests that near-Earth space rocks are more numerous than was once thought, and that their orbits may not be as stable as has been assumed. There is also reason to think that space rocks may not even need to reach Earth’s surface to cause cataclysmic damage. Our solar system appears to be a far more dangerous place than was previously believed.

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Unprotected Sex: Abstinence Education's Main Accomplishment

Youth seeking his father's advice on love
From the Haft Awrang of Jami, in the story A Father Advises his Son About Love. His counsel is to choose that lover who desires him for his inner beauty. See Sufi outlook on male love Freer and Sackler Galleries, Smithsonian Institution, Washington, DC.

It is widely known that teenage birth and pregnancy rates, which dropped dramatically between 1991 and 2005, are now climbing. By tracking changes in reported contraceptive use among sexually active high-school students, researchers at Columbia University and the Alan Guttmacher Institute, which studies sexual health, have identified as the leading culprit a drop in the use of birth control -- specifically condoms. The team studied trends in teen sexual activity and contraceptive use between 1991 and 2007. During most of this period, the level of sexual activity reported by teenagers in routine surveys overseen by the Centers for Disease Control remained largely unchanged. But during a crucial period -- identified in the study as between 1991 and 2003 -- the use of condoms rose dramatically, climbing from 46.2 percent in 1991 to 63.0 percent in 2003. Then a perceptible decline in the use of condoms began, with 61.5 percent of students reporting condom use in 2007. "These behavioral trends are consistent with the 2006 and 2007 increases in the teen birth rate," the study published in the July issue of the Journal of Adolescent Health says. "They may well portend further increases in 2008."
The decline in contraceptive use may cheer those who have promoted faith-inspired school curriculums that refuse to even mention birth control and, in some cases, specifically emphasize that condoms can fail. True enough.

But now we have sad and clear evidence that political foolishness among adults is leading to foolish and harmful behavior among kids. Who could reasonably want more teen pregnancies, more abortions among teenagers, more unmarried mothers, more babies born with greater health risks and with the sorely limited economic prospects that burden the children of young, single mothers? No one would dare promote such a policy. Yet these are the results of our recent national sex-education policy, which was based on religious faith, not science, and put political gamesmanship ahead of public health. More...

USA
Almost all U.S. students receive some form of sex education at least once between grades 7 and 12; many schools begin addressing some topics as early as grades 5 or 6. However, what students learn varies widely, because curriculum decisions are so decentralized. Many states have laws governing what is taught in sex education classes or allowing parents to opt out. Some state laws leave curriculum decisions to individual school districts.
For example, a 1999 study by the Guttmacher Institute found that most U.S. sex education courses in grades 7 through 12 cover puberty, HIV, STIs, abstinence, implications of teenage pregnancy, and how to resist peer pressure. Other studied topics, such as methods of birth control and infection prevention, sexual orientation, sexual abuse, and factual and ethical information about abortion, varied more widely.

Two main forms of sex education are taught in American schools: comprehensive and abstinence-only. Comprehensive sex education covers abstinence as a positive choice, but also teaches about contraception and avoidance of STIs when sexually active. A 2002 study conducted by the Kaiser Family Foundation found that 58% of secondary school principals describe their sex education curriculum as comprehensive.
Abstinence-only sex education tells teenagers that they should be sexually abstinent until marriage and does not provide information about contraception. In the Kaiser study, 34% of high-school principals said their school's main message was abstinence-only.

The difference between these two approaches, and their impact on teen behavior, remains a controversial subject. In the U.S., teenage birth rates had been dropping since 1991, but a 2007 report showed 3% increase from 2005 to 2006.[29] From 1991 to 2005, the percentage of teens reporting that they had ever had sex or were currently sexually active showed small declines. However, the U.S. still has the highest teen birth rate and one of the highest rates of STIs among teens in the industrialized world. Public opinion polls conducted over the years have found that the vast majority of Americans favor broader sex education programs over those that teach only abstinence, although abstinence educators recently published poll data with the opposite conclusion.
Proponents of comprehensive sex education, which include the American Psychological Association, the American Medical Association, the National Association of School Psychologists, the American Academy of Pediatrics, the American Public Health Association, the Society for Adolescent Medicine and the American College Health Association, argue that sexual behavior after puberty is a given, and it is therefore crucial to provide information about the risks and how they can be minimized; they also claim that denying teens such factual information leads to unwanted pregnancies and STIs.

On the other hand, proponents of abstinence-only sex education object to curricula that fail to teach their standard of moral behavior; they maintain that a morality based on sex only within the bounds of marriage is "healthy and constructive" and that value-free knowledge of the body may lead to immoral, unhealthy, and harmful practices. Within the last decade, the federal government has encouraged abstinence-only education by steering over a billion dollars to such programs. Some 25 states now decline the funding so that they can continue to teach comprehensive sex education. Funding for one of the federal government's two main abstinency-only funding programs, Title V, was extended only until December 31, 2007; Congress is debating whether to continue it past that date.
The impact of the rise in abstinence-only education remains a question. To date, no published studies of abstinence-only programs have found consistent and significant program effects on delaying the onset of intercourse. In 2007, a study ordered by the U.S. Congress found that middle school students who took part in abstinence-only sex education programs were just as likely to have sex (and use contraception) in their teenage years as those who did not. Abstinence-only advocates claimed that the study was flawed because it was too narrow and began when abstinence-only curricula were in their infancy, and that other studies have demonstrated positive effects.
It is estimated that more than half of all new HIV infections occur before the age of 25 and most are acquired through unprotected sex. According to the experts on AIDS, many of these new cases come about because young people don’t have the knowledge or skills to protect themselves. To try and resolve this problem the American Psychological Association (APA) is recommending that comprehensive sex education and HIV prevention programs become more available to the youth. The young people need this to help protect them from HIV/AIDS and other STDs they might get if they decide to have sex.

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Abstinence-only sex education is working, NOT!

http://www.nytimes.com/2007/12/06/health/0...

WASHINGTON, Dec. 5 ? The birth rate among teenagers 15 to 19 in the United States rose 3 percent in 2006, according to a report issued Wednesday, the first such increase since 1991. The finding surprised scholars and fueled a debate about whether the Bush administration?s abstinence-only sexual education efforts are working.

The federal government spends $176 million annually on such programs. But a landmark study recently failed to demonstrate that they have any effect on delaying sexual activity among teenagers, and some studies suggest that they may actually increase pregnancy rates.

http://hs.riverdale.k12.or.us/~hfinnert/exhib_06/carolinep/abstinence.gif

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The Netherlands
Subsidized by the Dutch government, the “Lang leve de liefde” (“Long Live Love”) package, developed in the late 1980s, aims to give teenagers the skills to make their own decisions regarding health and sexuality. Professor Brett van den Andrews, a medical research scientist who graduated from ISHSS (International School for Humanities and Social Sciences), has suggested that exposing children aged 4-7 to sex education will greatly reduce the risk of future pregnancies and health issues. Of course his theories have been the subject of much scrutiny under the NIGS (Netherlands Institute of Geooracular Sciences). Nonetheless, he is widely appreciated in the medical society and has been featured in many medical journals. Nearly all secondary schools provide sex education as part of biology classes and over half of primary schools discuss sexuality and contraception. The curriculum focuses on biological aspects of reproduction as well as on values, attitudes, communication and negotiation skills. The media has encouraged open dialogue and the health-care system guarantees confidentiality and a non-judgmental approach. The Netherlands has one of the lowest teenage pregnancy rates in the world, and the Dutch approach is often seen as a model for other countries.

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Sex education and public edification

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England and Wales
In England and Wales, sex education is not compulsory in schools as parents can refuse to let their children take part in the lessons. The curriculum focuses on the reproductive system, fetal development, and the physical and emotional changes of adolescence, while information about contraception and safe sex is discretionary and discussion about relationships is often neglected. Britain has one of the highest teenage pregnancy rates in Europe and sex education is a heated issue in government and media reports. In a 2000 study by the University of Brighton, many 14 to 15 year olds reported disappointment with the content of sex education lessons and felt that lack of confidentiality prevents teenagers from asking teachers about contraception. In a 2008 study conducted by YouGov for Channel 4 it was revealed that almost three in ten teenagers say they need more sex and relationships education.

Scotland
In Scotland, the main sex education program is Healthy Respect, which focuses not only on the biological aspects of reproduction but also on relationships and emotions. Education about contraception and sexually transmitted diseases are included in the program as a way of encouraging good sexual health. In response to a refusal by Catholic schools to commit to the program, however, a separate sex education program has been developed for use in those schools. Funded by the Scottish Government, the program Called to Love focuses on encouraging children to delay sex until marriage, and does not cover contraception, and as such is a form of abstinence-only sex education.

Inside Iran

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WTC7: NIST Finally Admits Freefall

NIST's Half-Admission of Yet Another 9/11 Smoking Gun



The U.S. Senate will hold a confirmation hearing this week on the nominee for Secretary of Commerce, Gov. Gary Locke. This cabinet position oversees the National Institute for Standards and Technology (NIST), the government agency responsible for investigating and reporting on the destruction of World Trade Center Building 7. NIST tried to avoid admitting that there was any freefall acceleration when the building came down on September 11, 2001. All the way to their draft final report on August 26, 2008, nearly seven years after the event, the NIST report's lead authors held firmly to their position that freefall did not occur.



Once NIST invited comments on its draft report, it was more or less forced to accept the indisputable explanations based on the publicly available videos proving that freefall had occurred. David Chandler, a high school physics teacher and AE911Truth researcher, provided the most compelling argument in a video seen widely on YouTube.

In their final report issued November 20, 2008, the NIST report's authors stated they had made a more detailed examination, and found a 2.25-second period in which the center roofline exhibited a "freefall drop for approximately 8 stories." Chandler had measured a 2.5-second period. For all practical purposes, the time period can be thought of as two seconds.



The NIST report did not state the significance of a freefall drop. The significance is that during that period of freefall, all of the gravitational energy (also known as potential energy) is converted to energy of motion (also known as kinetic energy). There is no energy available for doing other work, such as breaking up structural columns or hurling structural pieces out of the way. Figure 1 is an illustration depicting these points.

NIST tried to hide its admission of freefall from public view, by not listing it in the description of the changes it made in response to public comments. Admitting to freefall leads directly to the question, what source of energy eliminated the eight stories of building structure? Evidently the NIST authors didn't want to go there. The chart (figure 2) below speaks for itself. They tried to hide their dramatic change of position, that WTC7 did fall freely for two seconds. Gravitational forces alone can't come close to explaining how the building came down.

The two attached figures are intended as aids in explaining the NIST-freefall issue to influential non-technical people. U.S. senators and Gov. Locke need to receive this information early this week so the matter can be handled responsibly during the confirmation hearing.

If President Obama keeps his promise to restore science to its rightful place — above politics — there is a chance these two seconds will indeed live in infamy, with a full recognition of what they tell us about the nature of the 9/11 attacks, the Pearl Harbor of the 21st century. If, instead, he and his eventual Commerce Secretary bury these two seconds and their clear meaning, the infamy will fester and spread underground, continuing to undermine the public's understanding of what really happened on 9/11.

Figure 1

Figure 2

Final spacewalk leaves like-new Hubble ready for its final bow

Astronauts made all the needed repairs, giving the telescope five to 10 more years of life.
By Peter N. Spotts | Staff writer of The Christian Science Monitor
The crew of the space shuttle Atlantis has returned the Hubble Space Telescope to preeminent status.
Five successful spacewalks on five consecutive days have repaired and refurbished one of the most revolutionary observatories in the history of astronomy.
It's a bittersweet moment for those on the ground as well as those on orbit. A successful release of Hubble tomorrow marks the beginning of the end for the venerable telescope – its final five to 10 year period of research before it is sent plummeting into the Pacific Ocean.

But what a five to 10 years it is expected to be.

"We're looking forward to several years of exciting work," says Preston Burch, the telescope project's program manager at the Goddard Space Flight Center in Greenbelt, Md.
Targets range from galaxies in the very young universe billions of light-years away to planets orbiting other stars in the Milky Way.
To accomplish this, Hubble now "has a full arsenal of instruments," says Jon Morse, who heads the astrophysics division of NASA's Science Mission Directorate.
When it was launched in 1990, Hubble had five instruments. But embarrassing vision problems forced its architects to replace one instrument with a box of optics designed to correct the problem. Successive upgrades to the other instruments has rendered the box obsolete. It was removed on this flight and replaced with a cosmic-origins spectrograph – once again returning Hubble to five operating instruments.
In what experienced Hubble-repair hands have called true Hubble fashion, tasks that were easy in training turned out to be harder on orbit. By contrast, some of the tougher training tasks in NASA's oversized training pool, designed to simulate moving in weightlessness, were easier in space.


Still, spacewalkers had to handle the unexpected.

In wrapping up today's 8 hour, 2 minute outing, mission specialist John Grunsfeld bumped into one of the telescope's low-gain antennas while he was retrieving a piece of tape floating near Hubble during after-work clean-up. Clearly crestfallen, Dr. Grunsfeld was relieved to hear that the antenna was still working. As Grunsfeld wrapped up his work, a crewmember inside Atlantis's cabin radioed out: "Consider it a goodbye kiss, John."
Yesterday, mission specialist Mike Massimino had his own challenges repairing the Space Telescope Imaging Spectrograph – an instrument never designed for on-orbit repairs. Before he could get to the electronics card he had to replace, he had to remove a handrail, as well as a cover plate that was fastened with 111 tiny screws. One reluctant bolt on the handrail failed to yield to successively more powerful twists from the power tool Dr. Massimino was using – a tactic that had worked on a similarly balky bolt during the previous day's spacewalk. In the end, one final tug from Massimino himself freed the handrail.
In the process, the power tool's battery had failed, forcing him to go back to the air lock for a fresh battery and some additional oxygen for his space suit to ensure he'd have enough to finish the work.
By the end of Sunday's spacewalk, every task on the crew's long Hubble to-do list had been completed. And every test that engineers on the ground have given the newly installed or repaired instruments have returned the message: I'm OK.
"They accomplished more than we actually expected them to accomplish," says Dr. Burch Of Goddard Space Flight Center. It will now take weeks to perform setup tasks, such as aligning and focusing the instruments, he adds. The first "early observation" images should be ready in early September, he says.
Back on Atlantis, the fact that this would be astronauts' final house call on the telescope wasn't lost on the crew. From his perch on the work platform fastened to the shuttle's robotic arm, Grunsfeld snapped pictures for posterity as he and partner Drew Feustel tidied up the payload bay in preparation for releasing Hubble tomorrow.
This was Grunsfeld's third Hubble repair mission. As he eased his way to the air lock to join Dr. Feustel, the Earth slowly turned beneath the upside-down orbiter. Dan Burbank, the spacecraft communicator in mission control, called out: "John, take a moment more, you've earned it."

Higher Education Gone Wrong: Universities Are Turning into Corporate Drone Factories

Theodore Adorno

In decaying societies, politics become theater. The elite, who have hollowed out the democratic system to serve the corporate state, rule through image and presentation. They express indignation at AIG bonuses and empathy with a working class they have spent the last few decades disenfranchising, and make promises to desperate families that they know will never be fulfilled. Once the spotlights go on they read their lines with appropriate emotion. Once the lights go off, they make sure Goldman Sachs and a host of other large corporations have the hundreds of billions of dollars in losses they incurred playing casino capitalism repaid with taxpayer money.
We live in an age of moral nihilism. We have trashed our universities, turning them into vocational factories that produce corporate drones and chase after defense-related grants and funding. The humanities, the discipline that forces us to stand back and ask the broad moral questions of meaning and purpose, that challenges the validity of structures, that trains us to be self-reflective and critical of all cultural assumptions, have withered. Our press, which should promote such intellectual and moral questioning, confuses bread and circus with news and refuses to give a voice to critics who challenge not this bonus payment or that bailout but the pernicious superstructure of the corporate state itself. We kneel before a cult of the self, elaborately constructed by the architects of our consumer society, which dismisses compassion, sacrifice for the less fortunate, and honesty. The methods used to attain what we want, we are told by reality television programs, business schools and self-help gurus, are irrelevant. Success, always defined in terms of money and power, is its own justification. The capacity for manipulation is what is most highly prized. And our moral collapse is as terrifying, and as dangerous, as our economic collapse.Higher Education Gone Wrong: Universities Are Turning into Corporate Drone Factories
Theodor Adorno in 1967 wrote an essay called "Education After Auschwitz." He argued that the moral corruption that made the Holocaust possible remained "largely unchanged." He wrote that "the mechanisms that render people capable of such deeds" must be made visible. Schools had to teach more than skills. They had to teach values. If they did not, another Auschwitz was always possible.
All political instruction finally should be centered upon the idea that Auschwitz should never happen again," he wrote. "This would be possible only when it devotes itself openly, without fear of offending any authorities, to this most important of problems. To do this, education must transform itself into sociology, that is, it must teach about the societal play of forces that operates beneath the surface of political forms.
Our elites are imploding. Their fraud and corruption are slowly being exposed as the disparity between their words and our reality becomes wider and more apparent. The rage that is bubbling up across the country will have to be countered by the elite with less subtle forms of control. But unless we grasp the "societal play of forces that operates beneath the surface of political forms" we will be cursed with a more ruthless form of corporate power, one that does away with artifice and the seduction of a consumer society and instead wields power through naked repression.

I had lunch a few days ago in Toronto with Henry Giroux, professor of English and cultural studies at University in Canada and who for many years was the Waterbury Chair Professor at Penn State. Giroux, who has been one of the most prescient and vocal critics of the corporate state and the systematic destruction of American education, was driven to the margins of academia because he kept asking the uncomfortable questions Adorno knew should be asked by university professors. He left the United States in 2004 for Canada.
"The emergence of what Eisenhower had called the military-industrial-academic complex had secured a grip on higher education that may have exceeded even what he had anticipated and most feared," Giroux, who wrote "The University in Chains: Confronting the Military-Industrial-Academic Complex," told me. "Universities, in general, especially following the events of 9/11, were under assault by Christian nationalists, reactionary neoconservatives and market fundamentalists for allegedly representing the weak link in the war on terrorism. Right-wing students were encouraged to spy on the classes of progressive professors, the corporate grip on the university was tightening as made clear not only in the emergence of business models of governance, but also in the money being pumped into research and programs that blatantly favored corporate interests. And at Penn State, where I was located at the time, the university had joined itself at the hip with corporate and military power. Put differently, corporate and Pentagon money was now funding research projects and increasingly knowledge was being militarized in the service of developing weapons of destruction, surveillance and death. Couple this assault with the fact that faculty were becoming irrelevant as an oppositional force. Many disappeared into discourses that threatened no one, some simply were too scared to raise critical issues in their classrooms for fear of being fired, and many simply no longer had the conviction to uphold the university as a democratic public sphere."

Frank Donoghue, the author of "The Last Professors: The Corporate University and the Fate of the Humanities," details how liberal arts education has been dismantled. Any form of learning that is not strictly vocational has at best been marginalized and in many schools has been abolished. Students are steered away from asking the broad, disturbing questions that challenge the assumptions of the power elite or an economic system that serves the corporate state. This has led many bright graduates into the arms of corporate entities they do not examine morally or ethically. They accept the assumptions of corporate culture because they have never been taught to think.
Only 8 percent of college graduates now receive degrees in the humanities, about 110,000 students. Between 1970 and 2001, bachelor's degrees in English declined from 7.6 percent to 4 percent, as did degrees in foreign languages (2.4 percent to 1 percent), mathematics (3 percent to 1 percent), social science and history (18.4 percent to 10 percent). Bachelor's degrees in business, which promise the accumulation of wealth, have skyrocketed. Business majors since 1970-1971 have risen from 13.6 percent of the graduation population to 21.7 percent. Business has now replaced education, which has fallen from 21 percent to 8.2 percent, as the most popular major.

The values that sustain an open society have been crushed. A university, as John Ralston Saul writes, now "actively seeks students who suffer from the appropriate imbalance and then sets out to exaggerate it. Imagination, creativity, moral balance, knowledge, common sense, a social view -- all these things wither. Competitiveness, having an ever-ready answer, a talent for manipulating situations -- all these things are encouraged to grow. As a result amorality also grows; as does extreme aggressivity when they are questioned by outsiders; as does a confusion between the nature of good versus having a ready answer to all questions. Above all, what is encouraged is the growth of an undisciplined form of self-interest, in which winning is what counts."
This moral nihilism would have terrified Adorno. He knew that radical evil was possible only with the collaboration of a timid, cowed and confused population, a system of propaganda and a press that offered little more than spectacle and entertainment and an educational system that did not transmit transcendent values or nurture the capacity for individual conscience. He feared a culture that banished the anxieties and complexities of moral choice and embraced a childish hyper-masculinity, one championed by ruthless capitalists (think of the brutal backstabbing and deception cheered by TV shows like "Survivor") and Hollywood action heroes like the governor of California. "This educational ideal of hardness, in which many may believe without reflecting about it, is utterly wrong," Adorno wrote. "The idea that virility consists in the maximum degree of endurance long ago became a screen-image for masochism that, as psychology has demonstrated, aligns itself all too easily with sadism."
Sadism is as much a part of popular culture as it is of corporate culture. It dominates pornography, runs like an electric current through reality television and trash-talk programs and is at the core of the compliant, corporate collective. Corporatism is about crushing the capacity for moral choice. And it has its logical fruition in Abu Ghraib, the wars in Iraq and Afghanistan and our lack of compassion for the homeless, our poor, the mentally ill, the unemployed and the sick.
"The political and economic forces fuelling such crimes against humanity -- whether they are unlawful wars, systemic torture, practiced indifference to chronic starvation and disease or genocidal acts -- are always mediated by educational forces," Giroux said. "Resistance to such acts cannot take place without a degree of knowledge and self-reflection. We have to name these acts and transform moral outrage into concrete attempts to prevent such human violations from taking place in the first place."
The single most important quality needed to resist evil is moral autonomy. Moral autonomy, as Immanuel Kant wrote, is possible only through reflection, self-determination and the courage not to cooperate.
Moral autonomy is what the corporate state, with all its attacks on liberal institutions and "leftist" professors, has really set out to destroy. The corporate state holds up as our ideal what Adorno called "the manipulative character." The manipulative character has superb organizational skills and the inability to have authentic human experiences. He or she is an emotional cripple and driven by an overvalued realism. The manipulative character is a systems manager. He or she exclusively trained to sustain the corporate structure, which is why our elites are wasting mind-blowing amounts of our money on corporations like Goldman Sachs and AIG. "He makes a cult of action, activity, of so-called efficiency as such which reappears in the advertising image of the active person," Adorno wrote of this personality type. These manipulative characters, people like Lawrence Summers, Henry Paulson, Robert Rubin, Ben Bernanke, Timothy Geithner, AIG's Edward Liddy and Goldman Sachs CEO Lloyd Blankfein, along with most of our ruling class, have used corporate money and power to determine the narrow parameters of the debate in our classrooms, on the airwaves and in the halls of Congress while they looted the country.
"It is especially difficult to fight against it," warned Adorno, "because those manipulative people, who actually are incapable of true experience, for that very reason manifest an unresponsiveness that associates them with certain mentally ill or psychotic characters, namely schizoids."

Chris Hedges, a Pulitzer prize-winning reporter, is a Senior Fellow at the Nation Institute. His latest book is Collateral Damage: America's War Against Iraqi Civilians.