The posts that prompt me to think the most often grow out of conversations with others. The reason I’ve not placed anything new in the main part of the blog for a couple of days is that I’ve been occupied in the ‘comments’ section discussing the pros and cons of diagnostic labels with Marian, who authors Different Thoughts. That interchange can be found in the comments thread following my last post: ‘A rose by any other name would smell as sweet’ (see comments numbered ten through eighteen). As you may recall, that previous essay arose out of my reading of two pieces written by Larry, the author of the Hopeworks Community blog. (One of his posts talked about diagnosis, and the other about semantics.) If one were to compile Larry’s work with my essay and the conversation between Marian and me, the result would be a pretty thorough coverage of the pluses and minuses of using a medical/diagnostic model to classify mental conditions.

If you read my responses to Marian, you’ll also see how I ended up regretting some of my words. While sleepless and fatigued at 3:00 am, I got caught up in my emotions, in my desire to protect others from being criticized for their choices, and in my sense that my viewpoints had been brushed off. I succumbed to the strong feelings and diametric divergence of opinions that plague so many discussions in behavioral health. My words conveyed an antagonism that left me feeling bad when I awoke after a few hours of sleep. My biggest concern in writing about mental health often centers on trying not to alienate people who disagree with me. I hope to convince others to broaden their perspectives, and coming down with too much hostility will never accomplish that. So I had to ask myself why my words had gone against my principles. They had become personal attacks rather than dissections of Marian’s analysis or challenges to what she considers factual statements.

I am human. I realize that getting angry and overreacting go hand-in-hand with belonging to this species. So rather than berating myself for violating my standards, it is more useful for me to explore why my defenses broke down. What prompted me to jump into the fray with the kind of vehemence I object to in those who only hammer their opinion into others, and barely listen to the reasoned views of people with whom they disagree? Why did I back away from my belief that words should be used to promote mutual understanding and bring people to common ground, rather than widening divisions and increasing ill-will?

When I first became (peripherally and recently) involved in the activist side of the mental health world, the sharp and frequent contention surprised me. That I walked into this cause without expecting huge controversy must seem silly to others. But I had a utopian picture, coming from my limited and one-sided experience of psychological services in an institution where all the clinicians and clients accepted the same treatment model. In that milieu, everyone worked together to figure out how to help the clients feel better. I had not agreed with everything that organization did, but I respected the practitioners, and found the entire effort admirable. Good people working as a team to accomplish a worthwhile goal satisfies my hopes for human potential. I knew disagreements about treatment approaches existed, and had actually left a previous psychiatrist because I concluded she was harming me. Since my heart boiled with fury about awful and permanent side effects, and years lost with my mind poisoned by too much medication, I should have known that outside of my protected enclave I would find others who harbored similar anger and frustration. And that they would not all agree. It did not take long to catch on to the reality that feelings run very high, agreement is rare, and all sides bring a burden of resentment to the table. The conflict heightens further in the face of the power possessed by doctors, police, and social workers to strip us of our civil rights with only nominal proof of necessity. The fact that lives can be saved or ruined in short order further amplifies the rancor and controversy.

The most pernicious tendency leading to ill-will between people who desire the same end (improved mental health care) is how easily we get locked into believing that ‘our way is the only way’, and that those who disagree with us have nothing valid to offer. Why do we get caught in the trap of imagining we have the one and only answer to mental health issues? Why is it so hard to accept that others may have equally constructive suggestions? Even when two proposed ‘solutions’ are not mutually exclusive, it still can be tough to relax our grip on the cognitive framework we’ve built to guide our recovery. The temptation remains strong to undermine the other person’s ideas in favor of our own. Why do we have such a hard time tolerating alternatives to our approach?

For one thing, we are people who have suffered. If we are fortunate and persistent enough to transcend our distress, chaos and despair, then we feel tremendous gratitude toward the people or methods that escorted us out of hell. We put the process we followed on a pedestal, and feel almost worshipful in our attitude toward it. Our approach, whether it involved taking medication, mindfulness meditation, doing cognitive exercises, or working on our spirituality, feels so important to us that we cannot help but think it almost miraculous, perhaps even divinely inspired. This entity, whatever it is, has saved us from misery, confusion, and destruction. Like a beneficent god, our savior has earned our faith and devotion.

We also cling to our rescuer (whether person, institution, or philosophy), out of fear that we will fall back into the pit if we relax our embrace. We begin to think in nearly magical terms about the engine of our recovery. If we don’t do things just right our punishment might be a one-way bus ride back to the innermost circle of the underworld. Because so much of our well-being seems to depend on fidelity to this fount of salvation, it becomes easy to feel threatened when someone suggests that our cherished path to recovery has bumps and gaps. How could our road be flawed when it has led us away from enslavement by psychic demons? We fear that we might stumble if we allow others to question our route to mental equilibrium, and the road to wellness will then be closed to us. Sometimes, we even react negatively if somebody acknowledges that we have a good answer, but not the total answer. Worst of all is when another person is equally committed to a conflicting view about how to maintain equanimity. So two people end up screaming at each other, each clenching their lifeline with blood-drained knuckles, when they might just as well reach hands out to each other and share their supports.

At the same time as we defend our ‘answer’ against challengers, we feel called to spread the word about the salvation we have been granted. Like people who enter a spiritual tradition that brings them out of darkness and into life, we become evangelical, and want others to benefit from what worked for us. This response is both natural and laudable. Problems arise, however, when two people feel equally strongly about (seemingly) opposite philosophies. Neither wants anything to do with the other’s ‘theology’. Each feels the other is not only wrong, but possibly evil as well. Psychiatrists become demonized. Or people who advocate against medications are accused of endangering lives and families. The two camps quit listening or even talking to each other, and are content to just preach to those who already agree. One does not need to look far in our modern world to see the dangers when people cling with aggression to conflicting creeds. And it is not really a stretch to liken psychological therapies of all kinds to religious devotion and practice. Both church and mental health practices offer ‘answers’ in the midst of confusion. Both provide community and human contact. Both rescue people from despair. Both depend, to a large extent, on blind faith (read, placebo effect).

The demands of unquestioning devotion, and the resulting obstruction of reason, underly the swath of destruction that religious conflicts draw across our society. If people ‘believe’ without wondering whether there is any objective factual foundation for their ideologies, then there is no hope of communication between opposing camps. How can you persuade someone who doesn’t care about facts or logic and orders opinions on the basis of deep-seated emotional attachments? It is like two young boys arguing about who has the better mom. Empiricism and analysis have no role; each kid just ‘knows’ he has the best mother in the world. That may work for children in the school yard, where the worst consequence might be a bloody nose. But in the wider, adult world if people determine who to approve or reject, what to believe or disbelieve, and how to act or treat others by referring to nothing more than powerful sentiments, then we end up with terrorist attacks or high-tech bombardment of civilian populations.

Bringing the analogy back to the world of mental health: in the absence of careful research and good studies it is far too enticing to base one’s opinions on one’s own personal experience. That would be acceptable, perhaps, if every person could be counted on to respond the same way. However, my point from the start has been that we are all unique. We each have different tastes in people, places, and activities. We look at the world from different perspectives, and have different value structures. What seems perfect to one person may be abhorrent to another. If I conclude that my answer must be good for everyone only because it is good for me, I will soon find that most people have little inclination to believe me or even listen. A charismatic person (which I am not) can succeed in attracting a following. But as far as one person convincing the entire community that there is a single answer for all mental health problems, especially if the evidence supporting the ‘cure-all’ is based mainly on his or her individual experience, that is no more likely than having the world’s population agree on one religious faith. Different people need different solutions.

We also face the problem that people change and go through stages. What works for someone at one time may cease to work later on. In my most objective moments, and as much as I regret starting antidepressants in 1995, I have to admit that medications helped me in my thirties. Now, however, after many years of hard work, I have reconciled with past traumas. I adopted a philosophical and spiritual stance that allows me to tolerate thoughts and feelings that would have once been overwhelming. So I don’t feel the need to take mood-elevators anymore. But for me to turn around and tell a twenty-year-old to just live with their imploding emotions might be worse than forgetful or insensitive; it might even lead the person to self-destruct. And yet I have seen myself say just that kind of thing. It is all-too-easy to blind ourselves to how much we differ from those around us, or even from who we used to be or might be tomorrow.

Rancor arises when people become afraid to even consider that their ‘solution’ may have limitations. It seems to threaten us to entertain the notion that the answers we rely upon might let another person down. I believe the reason for this fear may be that if we acknowledge the possibility of our path to salvation failing someone else, then we admit the possibility that it could some day fail us too. When a path becomes so important to us (whether it’s a religion, a treatment philosophy, or just a point of view) that we think our survival depends on it, then we will naturally defend it against all attackers. Even those who mean well, truly want to help, and have well worked out ideas become enemies. Before long everyone who disagrees becomes an adversary rather than a fellow seeker. That is how good people end up screaming at each other, figuratively or in actuality.

That kind of back and forth helps no one. It drives people to become even more rigid in their views, causes hostile attitudes, and completely blocks communication and exchange of ideas. If any progress is to be made, we have to accept that other people are just as smart, just as creative, and just as capable of solving problems as we are. We have to recognize that writing off other people’s ideas as dumb or deluded amounts to tossing out a valuable resource.

There is really no reason for people to discount each other’s ideas about how to promote well-being. In my opinion, if there is a wrong way to solve the problem of troublesome mind conditions, it is to fall into the trap of thinking there is only one solution. If we can accept that more than one effective path may exist, or go even further and realize that using more than one method at a time may be a viable possibility, then we will be more inclined to listen to the ideas of our fellow travelers on the road to recovery.

In fact, it appears to me that most people benefit from using more than one approach. My progression was to start with therapy, and spend years confronting and understanding the effects of the severe trauma in my upbringing. From there I progressed to medications, which showed me how it felt to not be depressed, and proved to me that I did not endure despair simply because I somehow liked to be miserable. I learned that I was perfectly happy to be happy. After some dead-ends, detours, and misdirections, I learned how to use CBT and meditation to modulate my thoughts and feelings. Most recently, I’ve taken up treatment under the ACT model, and have begun to allow my mind freer rein. Along the way I explored AA, Alanon, support groups for adult children of alcoholics, and many other recovery programs. I studied a great deal about brain science and neurophysiology, psychiatry, and numerous self-help strategies. I spent long periods devoted to a couple of different spiritual traditions. My personal experience tells me that all these different methods have value. However, no single one of them worked as a total solution. So there is at least one person on this planet (me) who was not completely ‘cured’ by any of these methods. They all had benefits, but they all had limitations, too. And yet each approach has adherents convinced that they have found the one and only solution.

Not long ago I met (in a workshop) someone who teaches and does therapy in CBT (Cognitive Behavioral Therapy). He is convinced that CBT will solve all mood problems. If I try to tell him that was not my experience, he responds that I just did not do it right. But if a ‘miracle’ treatment is so dependent on being done ‘just right’, how miraculous is it?

Spiritual solutions are the same. If I don’t get the all-encompassing comfort that others get from ‘God’ then the response is that I don’t have enough faith. Or don’t pray enough. Or don’t go to enough services. If I object that I reach profound states of contentment and understanding with spiritual practice, but that I need more, all-too-often I encounter an annoying condescension. The implication is that my desire for additional support shows that I obviously have not reached the spiritual heights inhabited by people who are ‘serious’ about their sacred practice.

Hard-line atheists will say that even if faith helps, it’s only because of placebo effects, or delusion, or some other material explanation. They imply that I am naive if I think there is a supernatural realm in play. I am being non-scientific, and I am quite possibly not too smart. In one view, belief in God is a weakness of the human brain that evolved to help us deal with mortality. When someone tells you that an important part of your mental health regimen is merely a defect in the human genome, it tends to close off further discussion.

For a psychiatrist, if drugs don’t work, the problem is that the proper chemical agents have not yet been found. We just need to keep trying until we stumble upon the right cocktail. There is little acknowledgement that maybe in some cases there is no drug at all that will adequately eliminate the ‘symptom’. My previous psychiatrist had exactly zero knowledge about something as well established as CBT. She felt no need to refer me on for other approaches. She doggedly pursued the holy grail of the right medication cocktail, even as I descended ever further into emotional bankruptcy.

It never stops amazing me how people blind themselves to alternative explanations and methods. It may be because I am so skeptical of ‘truth’ that I have a hard time understanding how somebody can be so wedded to just one way of seeing things. Frankly, I am not sure a single ‘true’ explanation exists in most settings. The complexity of the world is such that one dimensional answers seldom apply. Matter is both wave and particle. That means that an electron, for instance, is both confined to one very small place, and spread over a broad region simultaneously. The situation is analogous to saying that if you look through one window of my house I appear to be seated in a chair, but if you look through a different window, my body is spread like a cloud throughout the entire neighborhood. That was the first paradox I learned in physics.

Another physical paradox is that you cannot know both exactly where an object is and how fast it is moving at the same time. There is an unbreakable material limit to the precision with which we can pin down ‘the facts’. It is like saying you can know I am in a tiny town called Greeley Hill, but have no idea whether I am standing on the street or driving a race car at 200 miles per hour. Or you determine that I am driving exactly 55 miles per hour, but can only say that I am somewhere in the North America. And it is not just that you can’t figure out the answer; in a fundamental way, precise answers simply do not exist.

Think about it: every object is two completely different things at one time, and absolute precision is unreachable. Although I have stated them simplistically, that is nevertheless a pair of facts that lie at the basis of our entire universe. If we live in such an uncertain and ill-defined universe, then should we really be insulting each other because our companion’s paradigm for complicated and poorly understood mental conditions is not the same as ours?

Of course, I have to close by pointing out that all this is just my opinion (except for the statements about fundamental physical reality, which are over-simplified but correct). Maybe I am wrong to accept every person as equally capable of figuring out their own minds. Maybe some people are actually so misguided that I should just ignore what they say. Maybe that would do more to protect others from harm than trying to engage all comers.

And maybe a single solution will be found some day. Everyone will read the same book, practice the same method, and find peace. If that happens, then that ‘answer’ will not only end the mental health dilemma, but will probably also collapse the power of religions to determine how people think. For if a validated solution to human angst were to be found, the majority of people would likely drift away from institutions that offer an outdated dogmatism. This would go a long way toward stopping war and strife. People will no longer need to argue about mental health techniques, or a lot of other things, because the answer to their pain will be in hand. To me, that kind of panacea does not sound likely. But I would be thrilled to be proven wrong.

Time to turn over a new blog leaf. Watching the growth in readership stall, and then the numbers start to dwindle, has happened twice since I began this blog (effectively July 1). Both changes occurred after I went nuts and wrote really long posts that had only a little to do with mental health. My tag-line is ‘Just another Mental Health and Spirituality Blog’, but the sites I visit are almost all mental health oriented. So far I’ve not found a spiritual blog community that would be receptive to my biologically-based views on ‘God’. Given that the conversation I’m entering revolves around psychiatric issues of one kind or another, I will try to keep my blog in line with that topic. You all are teaching me what interests you or, more to the point, what doesn’t. In the future I will put the long posts about memoir-related or spiritual topics on webpages separate from the main blog, and then just provide the links for those (few) who are intrigued. I also plan to (once again) try to keep the posts shorter. I’m not sure what my cut-off should be. Maybe under 600 words?

With this new resolve, and the fact that I am typing better today, my mood has improved. My left ring finger, wrapped in gauze, has the sensitivity and accuracy of an elbow. But it’s only real job is typing ‘s’ (‘w’ comes up rarely, and ‘x’ almost never); with practice, I am learning to get it right. As usual, my spirits bounce back when I accept things as they are. I need to be OK with my minor injury, and not hate myself for all it seems to imply about my loss of dexterity, trouble coming off Cymbalta, etc. (The things I whined about in my last post.) I need to recognize that blog stats are just numbers, and not the same as people. I need to be satisfied with having one or two commenters say they enjoyed a post. After all, that rewards me far more than when AwStats shows a large number of ‘visitors’ who may just be web-bots for all I know. I need to get used to the fact that my blog project will not take off immediately, may never take off, and that ‘taking off’ is not the goal anyway.

Like all of us, I have concerns about finding financial security. But the joy I get out of writing, and out of communicating with others who share my concerns, has nothing to do with money. I need to hold on to that truth, and not get distracted by my anxiety about paying the bills. As is so often the case, the rewards this task has brought me are different from the ones I hoped for. The large number of fine blogs, the difficulty in attracting attention, and the frustration of realizing people don’t want to hear my ‘loftiest’ ideas have made it obvious that notoriety and financial success are unlikely. On the other hand, I’ve made contact with special and sensitive people of like attitudes, and I am now writing far more than ever before. Even to someone with chronic desires for high-achievement (tempered only a little by a decade of failure), who was raised to value status and ‘winning’ over relationships and helping, those seem like pretty good results. Thank you to all of you who have helped me find this treasure.

My last several posts talked about depression. Actually, they mainly discussed anti depression, but that prompted the rationale for today’s installment: you can’t consider how to cure an illness (if it is one, vide infra) without knowing a little about it. So, what is depression, anyway?

The word gets tossed about more often than it gets defined. Here is the MedLinePlus medical dictionary definition:

(1) : a state of feeling sad (2) : a psychoneurotic or psychotic disorder marked especially by sadness, inactivity, difficulty with thinking and concentration, a significant increase or decrease in appetite and time spent sleeping, feelings of dejection and hopelessness, and sometimes suicidal thoughts or an attempt to commit suicide

Definition (1) is straightforward: feeling sad. Number (2) starts with feelings: sadness, plus dejection and hopelessness. It then captures both thought dysfunction (impaired thinking and concentration) and the ‘vegetative signs’ of depression (inactivity, appetite changes, and disordered sleep). The final component is suicidality, either in thought or action.

So to simplify we have: sad feelings, impaired thinking, changes in bodily functions, and suicide. Does that sound like depression to you?

Everything listed can be true for me to varying degrees at different times. What this source fails to mention, though other dictionaries probably would, is ‘anhedonia’ or loss of ability to experience pleasure. Inability to enjoy anything often constitutes the crux of depression for me. If I could experience pleasure, life would not look so hopeless. Maybe I would then be motivated to eat, sleep, and think properly. Life is meant to be enjoyed, after all.

Or is it? In my opinion, our culture has fed us a huge depressing lie: that the purpose of life is enjoyment. More likely, the purpose (if there is one) is to experience what life brings, whether good or bad. Enjoyment is nice but not central to a meaningful life.

I grew up in a well-to-do household with many financial advantages. I attended good schools, went to a fancy summer camp, and lived in a house with a panoramic ocean view. The neighborhood had lovely landscaping, access to mountain trails, and a kid could bicycle to the beach in twenty minutes.

However, it was not a happy childhood. For those interested, here is an incomplete list of the traumas I experienced:

• Intense parental discord starting with my earliest memories.
• Prolonged and isolated hospitalization at age three.
• Parental divorce at age four.
• Annual moves for the next six years.
• My mother suffered from clinical depression, with numerous hospitalizations and shock treatments.
• She killed herself when I was six.
• My father’s second wife (his former mistress during the marriage) abused me with breathtaking sadism.
• My father was narcissistic, suffered from alcoholism, and disliked children.
• My sister a psychotic break (precipitated by heavy LSD use) when I was ten.
• My stepmother inflicted sexual humiliation on me between the ages of eleven and fourteen.
• I became involved in drugs and alcohol at age twelve (daily use by age fourteen).

So I suffered a traumatic, unhappy childhood in pleasant and prosperous surroundings. My high school had its share of celebrity children, and the prevalent attitude was that life should be happy and fun. Money worries should not exist. Everyone should be gorgeous and sexy. The neighborhood was not far from Hollywood, and many of the kids I went to school with grew up to continue the tradition of exporting these standards to the entire world.

How realistic are these expectations? Not long ago I attended a support group where one African-American attender came from a different environment: crack sales on the corner; imprisoned or dead fathers; drive-by shootings; endemic destitution; pervasive squalor. He had trouble understanding the concept of depression. When he first received the diagnosis, apparently, he told his psychiatrist that his feelings of despondency and hopelessness were normal. That would be the natural conclusion for someone growing up in such a habitat, wouldn’t it? How many of his classmates expected to some day meet a gorgeous spouse from a well-to-do and intact family, spawn a couple of genius kids, develop a fascinating and lucrative career, and live to an advanced age surrounded by loving children and grandchildren? White middle to upper-middle class people do not think such dreams to be wildly unrealistic. Improbable, perhaps, but not out of the question. In the American ghettoes, however, to fantasize like that would appear psychotic to your companions.

Maybe we ought to look again at what modern life typically brings. A huge proportion of marriages end in divorce. Financial security is a fading dream. Death is inevitable and illness almost so. The chemical byproducts of industrialization degrade the planet, posing a very real threat of ecological collapse. People move all the time, making stable communities a historical memory. War never ends. We’re no longer surprised by genocide and terrorism. And meeting people who grew up in truly loving and healthy families happens almost as rarely as finding four-leafed clovers.

Does this sound like a world where we might expect to be happy? You could even ask, of course, if human existence has ever been conducive to widespread joy and contentment. So maybe sad feelings, dejection, and hopelessness are not pathological. I realize this is a ‘depressing’ viewpoint. But before we start drugging ourselves because we feel ‘sad’, we might ask if it is really a sickness or just a normal human reaction (especially for sensitive people with concern for others, like most of us who get diagnosed with depression).

I am not suggesting we just live in misery. I will continue to work against depression until my last breath, if necessary. But it helps to know the true enemy. Is it really my brain, the way the mental health system teaches? Do I need to conclude I am a ‘sick’ person because the combination of a horrible upbringing and living in a discouraging world has left me susceptible to sad feelings? Maybe those of us who feel the pain of this life are actually the sane ones. Could it be that happy people are just in denial?

OK, that last statement probably takes the point too far. Still, I do believe that sadness must be considered a natural reaction. Any discussion of depression treatment would do well to start from that realization. Then we can proceed to identify endless despair and lack of pleasure as on over-reaction, but perhaps not an entirely pathological one. So when we look at what we should do, we will know that what we are fighting is, in part, the state of the world. Then the problem becomes, how can we find tranquility in the face of all the problems?

Starting from that position, using a psychiatric medication is nothing but a band-aid that covers rather than heals. After all, we could suck cocaine into our noses and feel better. But is that the best way to deal with life on this planet? Psychiatrists and drug companies, if they bothered to read this, would go bananas at the comparison. They would insist that psychiatric pharmaceuticals have long half lives, produce sustained benefit, and don’t lead to life-destroying behavior. And in truth there is a quantitative difference in side effects and social problems. But there is no qualitative difference in philosophy. Whether you buy the drug in a pharmacy or on the sidewalk out front, you are still treating life’s pain with chemicals.

Personally, I think that is not the best approach. Better to learn tools to cope with the tragedy and hardship than to drug yourself until you no longer care about it. And it is possible to retrain yourself to find peace and satisfaction in life in the face of its heartache and struggle. However, you will probably still feel sad. Part of the reason I became so miserable was my belief that things should be better. As a child, I saw relatives with happy families, and I envied them. As an adult, I resented that my colleagues continued in their careers, while mine ended because of a badly damaged neck. My resistance to making peace with my fate, not the misfortune itself, made me miserable. Now that I can accept my hardships as not being all that unusual, and certainly not ‘unfair,’ I can just be sad, without abandoning all hope for joy. It is OK to be sad. It is natural, maybe even healthy. My goal is to learn to experience the sadness but also allow myself to bask in contentment from time to time.

I believe that sadness is not the problem, despite how the definition of depression emphasizes it. Anhedonia is the real enemy. The inability to enjoy anything because of sorrow is a confusion about how feelings work. You can be sad a lot, but still find things to enjoy. But to get to this point I have had to abandon the unrealistic expectations fed to me by our modern culture. What a lie to believe one should get through life without being seared to the bone by tragedy and suffering! The fact is, every human frame will sometimes feel the flames of hell. But in our hearts we can look around, see the autumn trees outside the hospice window, and smile despite the pain.

Not long ago I posted a ‘Tweet’: The surest path to satisfaction is to lower your standards. What surprises me is that I now actually accept that to be true.

In closing, I would like to point people toward Acceptance and Commitment Therapy. It is not a therapy so much as a philosophy of recognizing the truth, and even the beauty, of pain. You don’t need a therapist to ‘get it’ (try this book–and I’m not getting a kickback from Amazon). ACT is not all that different from Buddhism, actually. But it is a good path for westerners who need to escape our society’s crazy message that life is supposed to look like a TV commercial, while grief, defeat, illness, and pain are for losers.

In the end, every one of us loses everything we love. What could be sadder? The trick has been to allow sorrow to rain on my parade, and just keep marching and pounding that drum.

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Note: the author of Health and Life directs me to this article which expands on the topic of antidepressant (in)efficacy. It also cites the STAR*D study, which made a mammoth attempt to assess and compare treatments. The short form of their result is that drugs, and even accepted therapies, don’t work all that well. But such a short wrap-up does the project a disservice, since it studied issues that always get ignored by drug companies. Some day I may devote an essay to it.

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(I modified this post in several places on 2009 August 4, c. 13:45 PDT. I did not introduce any substantive changes in the message or opinion.)

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