Just because one doctor failed to follow the rules doesn't invalidate the entire field of psychiatry.
Scientology seems to be having a rough go of it lately, what with high-profile defections that include its leader's father and its founder's granddaughter. The organization also appears to be on the verge of losing Suri Cruise just as she's getting old enough to join in some of its special rituals. Even media titan Rupert Murdoch, well-acquainted with the attentions of conspiracy theorists and parliamentary inquiries alike, is on the record labeling Scientologists as "creepy, maybe even evil."
But Scientology is still heartily charging forth in its epic battle against the dark forces of psychiatry, sometimes scoring undeniable battlefield wins. Unfortunately, aided by unwitting state regulators and media, the Scientologists are slaying creaky old windmills, not the dragons they imagine. Founder L. Ron Hubbard considered the medical study and treatment of disordered thought, abnormal mood and bad behavior as something of a threat to the pseudo-scientific religion he devised to clear up all these matters. L. Ron baked in so much suspicion towards psychiatrists, I wonder if the group's founder wasn't concerned with what diagnosis shrinks might hand him if they ever got him on the couch.
Little wonder then that the Church of Scientology operates a subsidiary whose sole aim is to discredit and dismantle the field of psychiatry. The subsidiary flies by the benign moniker "Citizens Commission on Human Rights," which sounds like it might be a UN-affiliated NGO. The group incessantly employs classic propaganda techniques like trumpeting each instant of an errant psychiatrist as emblematic of the entire field. A favorite strategy is zeroing in on poorly funded government mental health facilities and blaming the clinicians who toil there for their lack of proper resources, rather than acknowledging the dearth of societal support for funding mental health care and the full array of community supports needed to deinstitutionalize the sickest patients. If anything, CCHR's campaigns undermine public support for mental health treatment, especially in countries with more unsophisticated representatives and gullible media.
When you watch self-congratulating CCHR videos cataloging shoddy conditions in the world's most underfunded and poorly managed mental health facilities over the years, Scientologists hope you'll accept their slippery logic that these events say something about the validity of psychiatry as a whole. Of course they do not, no more so than any case of medical malpractice in any field, in any country, brings down validity of medicine as a whole. Mental illnesses are disease processes rooted in biology still under research by medical scientists that require intervention by mental health clinicians who stay abreast of an evolving body of scientific knowledge. The auditing sessions and e-meters L. Ron prescribed bear no resemblance to this reality.
So you can see why any critically minded reader will want to know when Scientology is the driving force behind any given brouhaha. But readers of a recent four-article investigative series in the Austin American Statesman were instead informed that an enviably safe physical treatment was controversial as evidenced by the concerns of the humanitarians at CCHR, which was described only as "a mental health watchdog group." As the Statesman reported, CCHR succeeded in getting the Texas Department of State Health Services to investigate psychiatrist Allen Childs for conducting research without proper certification from his hospital's review board. Consumers of the newspaper series like the author of this article at the Austinist can be forgiven for getting the impression that a state hospital psychiatrist had actively experimented with a dangerous form of electrotherapy called Cranial Electrotherapy Stimulation (CES). Yet all public evidence suggests nothing of the sort occurred.
I do not believe that the Statesman or Texas officials knew they were also serving as functionaries in a Scientology campaign. If so I think that Scientology's role would have made its way into at least one of the four Statesman articles:
The articles report how CCHR complained to state officials about Dr. Childs publishing two studies (2005 and 2007) including patients from North Texas State Hospital without institutional review board (IRB) approval. Dr. Childs was working with a population of intellectually disabled adults prone towards violence that other state facilities couldn't treat, referring them to the North Texas facility because of its high-security behavior management unit. Dr. Childs realized that the CES treatment reduced the number of violent outbursts without any significant side effects, something medication couldn't do for these patients. He made CES part of his routine medical practice so as to use as little medication as possible. When he decided to report his experience to others, he should have gone to an IRB for the OK -- a panel of medical and community representatives who evaluate research designs for any potential risk to the participants. IRBs have the power to entirely veto projects or demand modifications to research protocols. Texas officials quickly found that no IRB approvals existed for Dr. Child's two papers, and their investigation snowballed from there. As reported in the final article, Dr. Childs resigned. He'd already wound down his practice at the hospital before this episode. He did not respond to the Statesman for comment (nor to the state inquiry, it appears).
The head of the University of Texas College of Pharmacy took a particular interest in the Statesman articles. Dean Lynn Crismon provided statistical and research design assistance for some of Dr. Child's CES research in the late 1980's and was shocked to read how his old associate had gone off the rails. His research back then included IRB approvals. But when I explained to Dr. Crismon that Scientology had successfully targeted his old research partner, their involvement instantly tempered his interpretation of the newspaper articles. A full time administrator now long after his brief association with Dr. Childs, Dr. Crismon went on to spend a significant portion of his research career evaluating methodologies for improving care in public mental health systems. He and his team were the sometime target of CCHR press releases that he believes distorted his record.
What provoked the ire of state hospital officials, the lack of IRB approval, was a bit of a moving target, Dr. Crismon pointed out. For most of Dr. Childs' career, IRB approval would not have been the standard for the type of research he was conducting. Dr. Childs was using a technology that had been FDA approved for over 30 years to treat depression, anxiety and insomnia and whose only known side effects (like headaches and tingling) are so rare, benign and self-limited they would be the envy of most pharmaceuticals. CES passed its most recent FDA safety review just this past March. Dr. Childs secured approval to use the device (marketed as Alpha Stim) from his hospital's therapeutics committee and by its ethics panel, then obtained proper consent from each patient before use. He went on to make this stimulator a part of his routine practice, finding that it helped lower aggression. So he started using it for that problem more and more. Other doctors followed suit.
This is a very common evolution in routine medical practice seen with any number of devices, procedures and medications. All doctors use treatments "off label." This isn't an experiment. Dr. Childs then decided to collect his cases and report about his success so other doctors could consider trying it themselves. There is no question that an IRB would have approved the study, in fact they most likely would have issued a "waiver." When a doctor is using his own clinical data and masking any information that could identify the individual patients involved, there is essentially no risk to the patients. A pro-active "experiment" is not occurring, only a review and synthesis of clinical records. The relevant federal regulation specifically excludes this type of work:
Research involving the collection or study of existing data, documents, records, pathological specimens, or diagnostic specimens, if these sources are publicly available or if the information is recorded by the investigator in such a manner that subjects cannot be identified, directly or through identifiers linked to the subjects.
It didn't become the norm for clinicians to ask IRBs to vet this kind of publication until around the year 2000, according to Dr. Crismon, who has served on IRB's for 19 years including a period as chairman of the Texas Behavioral Health IRB. Today the University of Florida tells its staff that case studies with three or fewer patients need not go before its IRB. That number appears to be an internally developed rule of thumb; federal statutes don't include any such guidance. Dr. Childs's 2005 paper involved nine patients.
CES raised red flags for Scientologists because of the "electrical" aspect. Scientology considers electroconvulsive therapy (aka "electroshock") to be torture, and has a penchant conflating other electrical treatments with that therapy. ECT can send an entire amp of current through the brain. By contrast CES operates on the level of hundreds of microamps, over a thousand times smaller. Worn on each earlobe, you can walk about and do your business while having a CES treatment for thirty minutes or an hour. Users have full control to take it off at any time. I tried it on my back once a few years ago and didn't feel anything (it is no longer "cranial" stimulation when applied to the back, of course). It's powered by a 9-volt battery.
Cranial electrotherapy stimulation has not entered the medical mainstream despite its many decades on medical supply store shelves. Its second-class status becomes obvious on the principle manufacturer's website which features heavy direct-to-consumer appeals. CES isn't important enough to be discussed in medical schools, and seems to be embraced only quite spottily in psychiatry, neurology and related fields. Its unpopularity doesn't stem from any concerns about safety, however; the general impression is that there are other, more effective and well-studied treatments available (including full-bore electroconvulsive therapy). Ironically, considering Scientology's concerns, many clinicians have trouble believing a few microamps can do anything. By all accounts, Dr. Childs is one of the true believers, speaking at conferences across the country. I spoke with a neurologist who recalled one of his talks in the 1990s. Dr. Childs came off overly enthusiastic but sincere, I am told.
Despite its place in the nightmares of Scientologists everywhere, electricity is reaching a new heyday in medicine thanks to more sophisticated and targeted technologies like transcranial magnetic stimulation and deep brain stimulation, both recent FDA-approved technologies that offer more anatomical localization than CES. As electrical stimulators continue to miniaturize and start recharging over the air, a great many medical applications lie ahead in the next few decades.
So Dr. Childs conducted a study that nobody questions would have met perfunctory approval, had he only bothered to submit it. He did his work in an era when norms for this type of research were evolving. I think these facts should attenuate our condemnation of his actions, which should not be viewed through the perverted lens of Scientology's hate for the psychiatric profession, but rather as the error of an overzealous clinician committed to doing anything he can do help some of the most helpless people in the state psychiatric population. There were other misdeeds uncovered in the course of the investigation: Dr. Childs is accused of filming some of his patients without their consent and speaking judgmentally about their behavior in a talk accompanied by the video; he did not disclose in his second paper that he had become a consultant for the device company after the first paper. These are serious charges and there are no available facts that mitigate them. I have not seen the video, so the excerpts as reported are out-of-context. Was video consent ever obtained? Was Dr. Childs consulting for Alpha Stim at the time of his 2007 paper? Dr. Childs is not cooperating with the state (it seems) or granting interviews, so we don't know.
This collection of errors is certainly enough for state officials to demand Dr. Child's resignation, particularly if he is unwilling to defend himself. But just as important in the whole affair is the fact that the state of Texas and the Austin American Statesman were made unwitting players in a staged production by the Church of Scientology, some of the greatest showmen on earth. They'd like Dr. Allen Childs's mistakes to go towards discrediting the entire field of psychiatry. The true lessons in this tale are wholly different. I've spoken with three people who knew Allen Childs and all describe a sincere and passionate and perhaps rather excitable man. He made no secret of the fact that he was submitting his cases for publication, and he appears to have been simply ignorant of the need for IRB approval; perhaps his ignorance extended to his use of video as well. Could the state hospital have done a better job of educating its staff and supporting their research? Did the journals prompt Dr. Childs for certification of his IRB approvals?
I will not give Dr. Childs the benefit of the doubt while he is able yet unwilling to speak for himself. However, I do not see any evidence that he harmed patients beyond using their images in the video (as described). In fact the results he reports warrant further randomized, controlled investigation. The resignation of this well-meaning psychiatrist means little for the safety of his former patients, but it means a lot to Scientology. If CCHR's new strategy is to comb the psychiatric literature for instances where an IRB is MIA, psychiatry had better prepare for battlefield earth.
The president addressed the quadrennial gathering like a campaign rally—talking to a group devoted to service as if it valued self interest.
Donald Trump continued his ongoing tour of cherished American institutions on Monday night, delivering yet another jarringly partisan speech to an apolitical audience—this one, comprised of tens of thousands still too young to vote.
During the campaign, his performance at the Al Smith dinner—where presidential candidates roast their rivals and themselves every four years—devolved into overt attacks on his opponent. Shortly after his election, he stunned CIA employees by delivering a campaign-style stump speech before the agency’s Memorial Wall. On Saturday, he surprised the crowd of uniformed personnel at the commissioning of the USS Gerald R. Ford by imploring them to lobby Congress in support of his agenda.
The internet’s favorite fact-checkers are caught in a messy dispute.
On Monday, the editorial staff of Snopes.com wrote a short plea for help. The post said that the site needed money to fund its operations because another company that Snopes had contracted with “continues to essentially hold the Snopes.com web site hostage.”
“Our legal team is fighting hard for us, but, having been cut off from all revenue, we are facing the prospect of having no financial means to continue operating the site and paying our staff (not to mention covering our legal fees) in the meanwhile,” the note continued.
It was a shocking message from a website that’s been around for more than 20 years—and that’s become a vital part of internet infrastructure in the #fakenews era. The site’s readers have responded. Already, more than $92,000 has been donated to a GoFundMe with a goal of $500,000.
There were numerous attempts to establish contact with the campaign and the transition team.
In trying to fend off suspicion of collusion with the Kremlin, Donald Trump Jr. and Jared Kushner have recently provided the public with two very interesting documents. Shoving responsibility for any outreach onto the Russian side, the two men have given us with a partial account of Russian methods in approaching the Trump camp in 2016.
If the accounts are true—and, given that their accounts have changed in the past, these latest accounts could change too—then, taken together, the Trump Jr. emails and Kushner’s statement show a Russian side that is experimenting with ways of getting the Trump team’s attention. They show a side that really is, as one former Obama administration official told me, “throwing spaghetti at the wall and seeing what would stick.”
Half a century ago, a senator battling a brain tumor took to the Senate floor, and secured his legacy.
None of us can choose how we are remembered. Most of us are not remembered at all. Senator John McCain knows that he will be remembered. He faces a choice about how his remarkable career will be noted in its autumnal phase.
McCain will of course be remembered most of all for his service, and sacrifice and bravery, as a naval aviator and then as prisoner of war in Vietnam. He should also be known for his efforts in his early days in politics to heal divisions within the United States over the Vietnam war, and then between Vietnam and the United States.
In the world of politics he is known and will probably be remembered as a steadfast personal friend, despite disagreements of party. Michael Lewis’s remarkable tale of McCain’s loyalty to the disabled and mostly forgotten one-time liberal champion Morris Udall is, well, an unforgettable example. More than most politicians, McCain has had dramatic moments of principle-above-party high-road stands, as when he told a Republican questioner that she should stop suggesting that his then-opponent for the presidency, Barack Obama, was “an Arab.” As Colin Powell later pointed out, McCain’s response fell an inch short of perfection, in that he answered the questioner by saying that Obama wasn’t “an Arab—he’s a decent family man.” Still, in real time and near the end of a bitter campaign it was brave, right, to his credit—and in character.
Thirty-one-year-old Ezra Cohen-Watnick holds the intelligence portfolio on the National Security Council—but almost everything about him is a mystery.
Just 24 days into his tenure as Donald Trump’s national-security adviser, Michael Flynn was forced to resign, having reportedly misled Vice President Mike Pence about his contacts with Russian officials. When Flynn departed, the men and women he’d appointed to the National Security Council grew nervous about their own jobs, and with good reason. The new national-security adviser, General H.R. McMaster, promptly began clearing out Flynn’s people, among them Dave Cattler, the deputy assistant to the president for regional affairs, Adam Lovinger, a strategic affairs analyst on loan from the Pentagon, and KT McFarland, Flynn’s deputy, who was eased out with the ambassadorship to Singapore. Even Steve Bannon, among the most powerful people in the White House, was removed from the meetings of the NSC Principal’s Committee, where he had been installed early on in the administration.
Three Atlantic staffers discuss “Stormborn,” the second episode of the seventh season.
Every week for the seventh season of Game of Thrones, three Atlantic staffers will discuss new episodes of the HBO drama. Because no screeners were made available to critics in advance this year, we'll be posting our thoughts in installments.
The rise in anti-Muslim violence under Modi suggests that the demons of the country’s past are very much alive.
One day in June, towards the end of Ramadan, two young Muslim brothers on a visit to Delhi to buy new clothes for Eid boarded a train to return home, three hours away. Soon, they became embroiled in a disagreement over seating with fellow passengers, which escalated into an argument over their religion. The other passengers taunted the boys, calling them “beef-eaters,” and pulling at their beards, one of the brothers later said. Eventually, the knives came out. By the time the train had passed the boys’ village, the assault was underway. Fifteen-year-old Junaid Khan was thrown out of the carriage one station past the boys’ stop; he had been stabbed multiple times, and was later declared dead at Civil Hospital in Palwal.
Terminating the special counsel would show recklessness, imply corruption, and irrevocably damage the country.
Last week, President Donald Trump fueled speculation that he might work to oust Robert Mueller, the former FBI director appointed to probe Russian interference in the 2016 presidential election. Trump could do so today, or tomorrow, or three months from now; the news could be announced in a televised speech, through a spokesperson, or even in a late night tweet sent on an impulse after his advisers have gone to bed.
If Trump fires Robert Mueller, few will be surprised. But if that happens, as the Department of Justice is thrown into chaos, as the American public sees its clearly expressed support for the special counsel disregarded, as the vital inquiry into the integrity of American elections stalls, as protesters take to the streets in a show of outrage at the affront to the rule of law, as the 2018 midterms morph into a referendum on the administration, and as American democracy reels into unknown territory, the House of Representatives should immediately impeach the president.
As Donald Trump’s troubles deepen, he keeps trying to shift attention to his old rival—but finds it no longer works like it used to.
Donald Trump’s brand-new communications director got a glimpse of the challenge he faces this weekend. As Anthony Scaramucci toured the Sunday shows, promising a new era of better relations and positive vibes, his boss was firing off his most active string of Twitter complaints in some time, taking shots at Democrats, Republicans, the press, James Comey, Robert Mueller, and—for the second time in less than a week—his own attorney general:
So why aren't the Committees and investigators, and of course our beleaguered A.G., looking into Crooked Hillarys crimes & Russia relations?
The president’s choice of words to describe Attorney General Jeff Sessions is bizarre, though the condescending mockery matches the tone he often uses for adversaries. To paraphrase Trump, somebody’s doing the beleaguering, and that person is Trump himself, who railed at Sessions during an interview with The New York Times last week, saying he wished he hadn’t appointed him, and that Sessions’s decision to recuse himself from the Russia investigation was unfair to Trump.
Partly, it’s simple rage. Mueller threatens Trump. And when Trump sees someone as a threat, he tries to discredit and destroy them—conventional norms of propriety, decency and legality be damned.
But there’s another, more calculated, reason. Trump and his advisors may genuinely believe that firing Mueller is a smart move. And if you put morality aside, and see the question in nakedly political terms, they may be right.
The chances that Mueller will uncover something damning seem very high. Trump has already admitted to firing former FBI Director James Comey over the Russia investigation. Donald Trump Jr. has already admitted to welcoming the opportunity to get dirt on Hillary Clinton from people he believed were representatives of the Russian government. Even if Mueller doesn’t accuse anyone of a crime, he’s likely to paint a brutal picture. And that’s just on the question of election collusion and obstruction of justice. If Mueller uses Russia to segue into Trump’s business dealings, who knows what he might find. An all-star team of legal and financial sleuths, with unlimited time and money, and the ability to subpoena documents and people, have been let loose on the affairs of a man whose own autobiographer called him a “sociopath.” No wonder Trump is scared.