Jim Krane of the Associated Press quotes analysts who seem to blame the high price of petroleum on the shambles in Iraq. Iraq could be exporting nearly 3 million barrels a day (bbd) if the guerrilla war was not resulting in massive sabotage. In 2005, Iraq did only 1.4 million bbd on average, down from 2.8 mn. bbd before the war. Not only is Iraqi production way off but Iraq actually imports over $4 billion a year in petroleum products taking them off the market for other consumers.I can't imagine that Iraq really is much of a factor here. The world petroleum production is on the order of 86 million barrels a day so the lost 1.4 million bbd of Iraq is about 1.6% of the total. Even if you factor in Iraq's imports (and remember it doesn't have much of an economy at the moment), I can't imagine that Iraq production issues account for very much of the current price spike. Some economists argue that there is a lot of speculation, including a security premium, built into the current price, because you have war and rumors of war going on in the Gulf. A ten percent security premium is the difference between paying $3.00 a gallon for gas and $2.70.The main problem in supply isn't raw petroleum production but a shortfall in world refining capacity. The rise in demand is partially seasonal with Americans hitting the road in the summer.Some economists seem to be arguing that over five to ten years, Iraq could have had an impact, if there hadn't been all that sabotage and if $30 bn. had been invested in the industry. The fact is that if Americans did some serious conservation they could reduce consumption by 1/3. Since they use about 20 million barrels a day of petroleum, they could replace the production of both Iraq and Iran all by themselves.But the last politician who dared tell you that was Jimmy Carter and no one will ever go on television and talk that way again who wants to hold public office.
__________________
Saturday, April 29, 2006
Sunday, February 19, 2006
Hieroglyphic Stairway
it’s 3:23 in the morningand I’m awakebecause my great great grandchildrenwon’t let me sleepmy great great grandchildrenask me in dreamswhat did you do while the planet was plundered?what did you do when the earth was unraveling?surely you did somethingwhen the seasons started failing?as the mammals, reptiles, and birds were all dying?did you fill the streets with protestwhen democracy was stolen?what did you doonce you knew?I’m riding home on the Colma trainI’ve got the voice of the milky way in my dreamsI have teams of scientistsfeeding me data dailyand pleading I immediatelyturn it into poetryI want just this consciousness reachedby people in range of secret frequenciescontained in my speechI am the desirous earthequidistant to the underworldand the flesh of the starsI am everything already lostthe moment the universe turns transparentand all the light shoots through the cosmosI use words to instigate silenceI’m a hieroglyphic stairwayin a buried Mayan citysuddenly exposed by a hurricanea satellite circling earthfinding dinosaur bonesin the Gobi desertI am telescopes that see back in timeI am the precession of the equinoxes,the magnetism of the spiraling seaI’m riding home on the Colma trainwith the voice of the milky way in my dreamsI am myths where violets blossom from bloodlike dying and rising godsI’m the boundary of timesoul encountering souland tongues of fireit’s 3:23 in the morningand I can’t sleepbecause my great great grandchildrenask me in dreamswhat did you do while the earth was unraveling?I want just this consciousness reachedby people in range of secret frequenciescontained in my speech
drew dellinger©2003
drew dellinger©2003
Friday, January 27, 2006
Hypothetical President
This is of course an entirely hypothetical question, but what would happen if, in some future administration, a President of the United States lost his marbles?
Charles Manson could look Presidential, if you sprang him from prison, bought him a nice suit, gave him a shave, and taught him to smile for the cameras. A President is human like anyone else, so in theory, any President could go over the edge.
What if the power of the Presidency went to a hypothetical President's head, and he became psychotic or otherwise mentally unstable? If a hypothetical President went bananas, but maintained the ability to smile smoothly for the cameras, and spoke in a soft tone of voice whenever he was in public, how would we know he was nuts?
What if, in the privacy of the Oval Office, The President ordered his political opponents spied upon, swore vengeance on imagined enemies, and commanded attacks on nations that posed no threat to America?
What if the people who surrounded this madman wanted to keep his craziness a secret? What if his political cronies decided -- perhaps in good conscience, or perhaps for nefarious purpose -- to simply cut the deranged president "out of the loop," make decisions without him, and use him only as a camera-friendly figurehead?
These are tough questions, and aren't you glad they're only hypothetical? It would be a real dilemma if it ever really happened, because no matter how stale a fruitcake in the White House became, he would still be The President.
It would make no difference whether he was a Democrat, a Republican, or a Whig. Whatever his politics, the people in his own party would naturally want to overlook his shortcomings, and any outspoken opposition from another party would be portrayed as shrill politics from hypothetical-President-haters.
Why, even if The President sent hundreds of thousands of American troops into wars against a nation or two which presented no danger at all to America, he would still be The President. Even if his needless wars killed thousands of American soldiers, sailors, airmen and Marines, The President could just shrug and claim that anyone who wanted to end the wars didn't "support the troops."
And even if his wars without reason left hundreds of thousands of foreigners dead, still, if The President rattled sabers and threatened war against a third nation that couldn't harm America, or maybe even a fourth nation, many Americans would stand behind him.
After all, they would say, we're at war. We have to stand behind our Commander-in-Chief.
Perhaps this imaginary, unhinged President would try to keep more and more of his policies and actions secret, and refuse to allow serious investigations into any aspect of his administration. Perhaps he would sidestep any question by simply saying "national security" is at stake, and refusing to answer.
And many Americans would say, we're at war. We have to stand behind our Commander-in-Chief.
Perhaps this un-named, completely hypothetical but completely insane President would make chilling speeches, explaining that public debate remains acceptable, but harsh criticism is now over the line. It's treasonous to disagree, he could say -- it's aiding and abetting the enemy, and it's lowering the morale of US troops.
And many Americans would agree, enthusiastically. We're at war, they would echo, so we have to stand behind our Commander-in-Chief.
Perhaps a President, hypothetically out of his hypothetical mind, might ignore the Constitution, break laws left and right, and openly claim the power to rewrite or ignore any law. It might be worrisome to imagine it, but hypothetically, a bonkers administration might seize and hold thousands of people in secret prisons, without ever charging them with a crime. The President could even make torture an official US policy, while unblinkingly telling Americans that our nation would never torture.
No matter what an administration of maniacs might do, millions of Americans would still say it's downright un-American to speak against The President while we're at multiple wars. And so the wars would keep coming, wars without any sane purpose, but wars without end.
That's one hell of a catch, that Catch 22. The President gains special powers while we're at war, and it's un-American to question the validity of any war underway, and it's unpatriotic to criticize The President while we're at war ... but the wars never end.
In such a speculative setting, where would you stand? Could you see past your own politics, and recognize a madman when he gives the State of the Union address? Would you remain loyal to your political party's man no matter what -- or would you be loyal to your nation, its laws, its Constitution, its troops, and the freedoms they fought to establish and defend?
Thursday, January 12, 2006
BACK PAGE HERO
Honors for My Lai Hero Came Much Too Late
by Mike Boehm
Lost among the headlines about Iraq and secret detentions was the story of the death last week of a hero and a patriot: Hugh Thompson.
In 1998, Thompson was awarded the Soldier's Medal, for heroism not involving conflict with an enemy, for his actions to save civilians in My Lai, Vietnam, on March 16, 1968. Thompson died of cancer Friday morning in Alexandria, La., at the age of 62.
Reading the press coverage of the presentation of the Soldier's Medal to Army pilot Thompson and his two helicopter crewmen, Larry Colburn and Glenn Andreotta, could leave the impression that the award was the culmination of a natural and just process.
These three heroes, led by Thompson, rescued 10 Vietnamese villagers who were about to be killed by American soldiers, and they were responsible for stopping the My Lai massacre, led by Lt. William Calley Jr.
It took 30 years for Thompson to receive proper recognition for his actions that day, 30 years before it became safe to honor him for standing up to fellow American soldiers.
Hugh Thompson believed deeply that the military was an honorable profession and that in time of war it was important to behave in an honorable way. He paid a heavy price for his beliefs.
Flying a reconnaissance mission over My Lai that March day, Thompson looked down to see carnage. Bodies of Vietnamese villagers were strewn over the ground, and he could see 10 villagers huddled in a bunker as Calley's soldiers approached them. Thompson landed his helicopter and ordered Colburn, his gunner, to train his machine gun on the American GIs. He told Colburn to "open up" on them if they began firing on the Vietnamese. Then Thompson coaxed out the terrified villagers using hand signals and radioed for another helicopter to come rescue them.
When it became known what Thompson and his crew did to stop the My Lai massacre, his life became a living hell. He was nearly court-martialed for his actions. He was shunned by fellow pilots, dead animals were thrown on his doorstep, and he received death threats.
Contrast this behavior with the treatment of Calley. When he was finally sentenced to life in prison, the outcry by the American people against the sentence persuaded President Nixon eventually to pardon Calley. The lieutenant served only three years under house arrest, with organizations such as the American Legion raising funds for his defense.
Judging by the treatment of these two men, who did the American people really see as a hero?
The betrayal Thompson felt was so profound he never recovered from it and spent the rest of his life committing suicide by alcohol.
This feeling of betrayal is something most veterans have in common. All of us were taught to know right from wrong, to know good from evil. We trusted our institutions our government and our schools. We listened to so many of our churches promoting war and bowed our heads as our chaplains prayed over us to be successful in killing other human beings. We trusted our parents, who told us we were doing the right thing, and then we went to war in Vietnam (and now Iraq) and found we had been duped. We had been tricked into committing evil.
It comes as no surprise, after having the very foundations of life betrayed, that so many veterans have committed suicide. Or that so many veterans end up in jail or homeless or addicted to drugs.
Referring to the men who took part in the massacre at My Lai, Ron Ridenhour wrote in "Four Hours in My Lai": "Only a few people in those circumstances had the presence of mind and the strength of their own character that would see them through. ... Only an extraordinary few could withstand the pressures and maintain their moral beings in that awful place, in those terrible conditions. ... But we shouldn't our society shouldn't be structured ... so that only the extraordinary few can conduct themselves in a moral fashion."
Think about this. We are horrified when we hear about the massacres perpetrated in Vietnam and Iraq, and yet our society created the conditions for these atrocities to happen.
These atrocities will not end until we Americans, all of us, whether we were soldiers or not, recognize our own culpability. Like most Americans, I lived with the myth that as an American I could not possibly commit evil and that those Americans who did were deviants. It took me years to realize that the only difference between me and those who committed the massacre at My Lai (or Auschwitz or Nanking or Rwanda) was that I was lucky; I wasn't there. I had to face the deeper truth that the capacity for evil exists in all of us.
As long as there is war there will be atrocities and the need for the courage of men like Hugh Thompson. Only through the abolition of war will there finally be an end to atrocities.
by Mike Boehm
Lost among the headlines about Iraq and secret detentions was the story of the death last week of a hero and a patriot: Hugh Thompson.
In 1998, Thompson was awarded the Soldier's Medal, for heroism not involving conflict with an enemy, for his actions to save civilians in My Lai, Vietnam, on March 16, 1968. Thompson died of cancer Friday morning in Alexandria, La., at the age of 62.
Reading the press coverage of the presentation of the Soldier's Medal to Army pilot Thompson and his two helicopter crewmen, Larry Colburn and Glenn Andreotta, could leave the impression that the award was the culmination of a natural and just process.
These three heroes, led by Thompson, rescued 10 Vietnamese villagers who were about to be killed by American soldiers, and they were responsible for stopping the My Lai massacre, led by Lt. William Calley Jr.
It took 30 years for Thompson to receive proper recognition for his actions that day, 30 years before it became safe to honor him for standing up to fellow American soldiers.
Hugh Thompson believed deeply that the military was an honorable profession and that in time of war it was important to behave in an honorable way. He paid a heavy price for his beliefs.
Flying a reconnaissance mission over My Lai that March day, Thompson looked down to see carnage. Bodies of Vietnamese villagers were strewn over the ground, and he could see 10 villagers huddled in a bunker as Calley's soldiers approached them. Thompson landed his helicopter and ordered Colburn, his gunner, to train his machine gun on the American GIs. He told Colburn to "open up" on them if they began firing on the Vietnamese. Then Thompson coaxed out the terrified villagers using hand signals and radioed for another helicopter to come rescue them.
When it became known what Thompson and his crew did to stop the My Lai massacre, his life became a living hell. He was nearly court-martialed for his actions. He was shunned by fellow pilots, dead animals were thrown on his doorstep, and he received death threats.
Contrast this behavior with the treatment of Calley. When he was finally sentenced to life in prison, the outcry by the American people against the sentence persuaded President Nixon eventually to pardon Calley. The lieutenant served only three years under house arrest, with organizations such as the American Legion raising funds for his defense.
Judging by the treatment of these two men, who did the American people really see as a hero?
The betrayal Thompson felt was so profound he never recovered from it and spent the rest of his life committing suicide by alcohol.
This feeling of betrayal is something most veterans have in common. All of us were taught to know right from wrong, to know good from evil. We trusted our institutions our government and our schools. We listened to so many of our churches promoting war and bowed our heads as our chaplains prayed over us to be successful in killing other human beings. We trusted our parents, who told us we were doing the right thing, and then we went to war in Vietnam (and now Iraq) and found we had been duped. We had been tricked into committing evil.
It comes as no surprise, after having the very foundations of life betrayed, that so many veterans have committed suicide. Or that so many veterans end up in jail or homeless or addicted to drugs.
Referring to the men who took part in the massacre at My Lai, Ron Ridenhour wrote in "Four Hours in My Lai": "Only a few people in those circumstances had the presence of mind and the strength of their own character that would see them through. ... Only an extraordinary few could withstand the pressures and maintain their moral beings in that awful place, in those terrible conditions. ... But we shouldn't our society shouldn't be structured ... so that only the extraordinary few can conduct themselves in a moral fashion."
Think about this. We are horrified when we hear about the massacres perpetrated in Vietnam and Iraq, and yet our society created the conditions for these atrocities to happen.
These atrocities will not end until we Americans, all of us, whether we were soldiers or not, recognize our own culpability. Like most Americans, I lived with the myth that as an American I could not possibly commit evil and that those Americans who did were deviants. It took me years to realize that the only difference between me and those who committed the massacre at My Lai (or Auschwitz or Nanking or Rwanda) was that I was lucky; I wasn't there. I had to face the deeper truth that the capacity for evil exists in all of us.
As long as there is war there will be atrocities and the need for the courage of men like Hugh Thompson. Only through the abolition of war will there finally be an end to atrocities.
Tuesday, December 27, 2005
Looks Likes Vets will get the shaft again!
A Political Debate On Stress Disorder...
As Claims Rise, VA Takes Stock
The spiraling cost of post-traumatic stress disorder among war veterans has triggered a politically charged debate and ignited fears that the government is trying to limit expensive benefits for emotionally scarred troops returning from Iraq and Afghanistan.
In the past five years, the number of veterans receiving compensation for the disorder commonly called PTSD has grown nearly seven times as fast as the number receiving benefits for disabilities in general, according to a report this year by the inspector general of the Department of Veterans Affairs. A total of 215,871 veterans received PTSD benefit payments last year at a cost of $4.3 billion, up from $1.7 billion in 1999 -- a jump of more than 150 percent.
Experts say the sharp increase does not begin to factor in the potential impact of the wars in Iraq and Afghanistan, because the increase is largely the result of Vietnam War vets seeking treatment decades after their combat experiences. Facing a budget crunch, experts within and outside the Veterans Affairs Department are raising concerns about fraudulent claims, wondering whether the structure of government benefits discourages healing, and even questioning the utility and objectivity of the diagnosis itself.
"On the one hand, it is good that people are reaching out for help," said Jeff Schrade, communications director for the Senate Veterans Affairs Committee. "At the same time, as more people reach out for help, it squeezes the budget further."
Among the issues being discussed, he said, was whether veterans who show signs of recovery should continue to receive disability compensation: "Whether anyone has the political courage to cut them off -- I don't know that Congress has that will, but we'll see."
Much of the debate is taking place out of public sight, including an internal VA meeting in Philadelphia this month. The department has also been in negotiations with the Institute of Medicine over a review of the "utility and objectiveness" of PTSD diagnostic criteria and the validity of screening techniques, a process that could have profound implications for returning soldiers.
The growing national debate over the Iraq war has changed the nature of the discussion over PTSD, some participants said. "It has become a pro-war-versus-antiwar issue," said one VA official who spoke on the condition of anonymity because politics is not supposed to enter the debate. "If we show that PTSD is prevalent and severe, that becomes one more little reason we should stop waging war. If, on the other hand, PTSD rates are low . . . that is convenient for the Bush administration."
As to whether budget issues and politics are playing a role in the agency's review of PTSD diagnosis and treatment, VA spokesman Scott Hogenson said: "The debate is over how to provide the best medical services possible for veterans."
People with PTSD have paralyzing memories of traumatic episodes they experienced or witnessed, a range of emotional problems, and significant impairments in day-to-day functioning. Underlying the political and budget issues, many experts acknowledged, is a broader scientific debate over how best to diagnose trauma-related pathology, what the goal of treatment should be -- even what constitutes trauma.
Harvard psychologist Richard J. McNally argues that the diagnosis equates sexual abuse, car accidents and concentration camps, when they are entirely different experiences: A PTSD diagnosis has become "a way of moral claims-making," he said. "To underscore the reprehensibility of the perpetrator, we say someone has been through a traumatic event."
Chris Frueh, director of the VA clinic in Charleston, S.C., said the department's disability system encourages some veterans to exaggerate symptoms and prolong problems in order to maintain eligibility for benefits.
"We have young men and women coming back from Iraq who are having PTSD and getting the message that this is a disorder they can't be treated for, and they will have to be on disability for the rest of their lives," said Frueh, a professor of public psychiatry at the Medical University of South Carolina. "My concern about the policies is that they create perverse incentives to stay ill. It is very tough to get better when you are trying to demonstrate how ill you are."
Most veterans whom Frueh treats for PTSD are seeking disability compensation, he said. Veterans Affairs uses a sliding scale; veterans who are granted 100 percent disability status receive payments starting at around $2,300 a month. The VA inspector general's report found that benefit payments varied widely in states and said that was because VA centers in some states are more likely to grant veterans 100 percent disability.
Psychiatrist Sally Satel, who is affiliated with the conservative American Enterprise Institute, said an underground network advises veterans where to go for the best chance of being declared disabled. The institute organized a recent meeting to discuss PTSD among veterans.
Once veterans are declared disabled, they retain that status indefinitely, Frueh and Satel said. The system creates an adversarial relationship between doctors and patients, in which veterans sometimes take legal action if doctors decline to diagnose PTSD, Frueh said. The clinician added that some patients who really need help never get it because they are unwilling to undergo the lengthy process of qualifying for disability benefits, which often requires them to repeatedly revisit the painful episodes they experienced.
The concern by Frueh and Satel about overdiagnosis and fraud -- what researchers call "false positives" -- has drawn the ire of veterans groups and many other mental health experts.
A far bigger problem is the many veterans who seek help but do not get it or who never seek help, a number of experts said. Studies have shown that large numbers of veterans with PTSD never seek treatment, possibly because of the stigma surrounding mental illness.
"There are periodic false positives, but there are also a lot of false negatives out there," said Terence M. Keane, one of the nation's best-known PTSD researchers, who cited a 1988 study on the numbers of veterans who do not get treatment. "Less than one-fourth of people with combat-related PTSD have used VA-related services."
Larry Scott, who runs the clearinghouse http://www.vawatchdog.org/ , said conservative groups are trying to cut VA disability programs by unfairly comparing them to welfare.
Compensating people for disabilities is a cost of war, he said: "Veterans benefits are like workmen's comp. You went to war. You were injured. Either your body or your mind was injured, and that prevents you from doing certain duties and you are compensated for that."
Scott said Veterans Affairs' objectives were made clear in the department's request to the Institute of Medicine for a $1.3 million study to review how PTSD is diagnosed and treated. Among other things, the department asked the institute -- a branch of the National Academies chartered by Congress to advise the government on science policy -- to review the American Psychiatric Association's criteria for diagnosing PTSD. Effectively, Scott said, Veterans Affairs was trying to get one scientific organization to second-guess another.
PTSD experts summoned to Philadelphia for the two-day internal "expert panel" meeting were asked to discuss "evidence regarding validity, reliability, and feasibility" of the department's PTSD assessment and treatment practices, according to an e-mail invitation obtained by The Washington Post. The goal, the e-mail added, is "to improve clinical exams used to help determine benefit payments for veterans with Post Traumatic Stress Disorder."
"What they are trying to do is figure out a way not to diagnose vets with PTSD," said Steve Robinson, executive director of the National Gulf War Resource Center, a veterans advocacy group. "It's like telling a patient with cancer, 'if we tell you, you don't have cancer, then you won't suffer from cancer.' "
Hogenson, the VA spokesman, said the department is not seeking to overturn the established psychiatric criteria for diagnosing PTSD.
"We are reviewing the utility and the objectivity of the criteria . . . and are commenting on the screening instruments used by VA," he said. "We want to make sure what we do for screening comports with the latest information out there."
===========================
By Shankar Vedantam
Washington Post Staff Writer-Tuesday, December 27, 2005
© 2005 The Washington Post Company
As Claims Rise, VA Takes Stock
The spiraling cost of post-traumatic stress disorder among war veterans has triggered a politically charged debate and ignited fears that the government is trying to limit expensive benefits for emotionally scarred troops returning from Iraq and Afghanistan.
In the past five years, the number of veterans receiving compensation for the disorder commonly called PTSD has grown nearly seven times as fast as the number receiving benefits for disabilities in general, according to a report this year by the inspector general of the Department of Veterans Affairs. A total of 215,871 veterans received PTSD benefit payments last year at a cost of $4.3 billion, up from $1.7 billion in 1999 -- a jump of more than 150 percent.
Experts say the sharp increase does not begin to factor in the potential impact of the wars in Iraq and Afghanistan, because the increase is largely the result of Vietnam War vets seeking treatment decades after their combat experiences. Facing a budget crunch, experts within and outside the Veterans Affairs Department are raising concerns about fraudulent claims, wondering whether the structure of government benefits discourages healing, and even questioning the utility and objectivity of the diagnosis itself.
"On the one hand, it is good that people are reaching out for help," said Jeff Schrade, communications director for the Senate Veterans Affairs Committee. "At the same time, as more people reach out for help, it squeezes the budget further."
Among the issues being discussed, he said, was whether veterans who show signs of recovery should continue to receive disability compensation: "Whether anyone has the political courage to cut them off -- I don't know that Congress has that will, but we'll see."
Much of the debate is taking place out of public sight, including an internal VA meeting in Philadelphia this month. The department has also been in negotiations with the Institute of Medicine over a review of the "utility and objectiveness" of PTSD diagnostic criteria and the validity of screening techniques, a process that could have profound implications for returning soldiers.
The growing national debate over the Iraq war has changed the nature of the discussion over PTSD, some participants said. "It has become a pro-war-versus-antiwar issue," said one VA official who spoke on the condition of anonymity because politics is not supposed to enter the debate. "If we show that PTSD is prevalent and severe, that becomes one more little reason we should stop waging war. If, on the other hand, PTSD rates are low . . . that is convenient for the Bush administration."
As to whether budget issues and politics are playing a role in the agency's review of PTSD diagnosis and treatment, VA spokesman Scott Hogenson said: "The debate is over how to provide the best medical services possible for veterans."
People with PTSD have paralyzing memories of traumatic episodes they experienced or witnessed, a range of emotional problems, and significant impairments in day-to-day functioning. Underlying the political and budget issues, many experts acknowledged, is a broader scientific debate over how best to diagnose trauma-related pathology, what the goal of treatment should be -- even what constitutes trauma.
Harvard psychologist Richard J. McNally argues that the diagnosis equates sexual abuse, car accidents and concentration camps, when they are entirely different experiences: A PTSD diagnosis has become "a way of moral claims-making," he said. "To underscore the reprehensibility of the perpetrator, we say someone has been through a traumatic event."
Chris Frueh, director of the VA clinic in Charleston, S.C., said the department's disability system encourages some veterans to exaggerate symptoms and prolong problems in order to maintain eligibility for benefits.
"We have young men and women coming back from Iraq who are having PTSD and getting the message that this is a disorder they can't be treated for, and they will have to be on disability for the rest of their lives," said Frueh, a professor of public psychiatry at the Medical University of South Carolina. "My concern about the policies is that they create perverse incentives to stay ill. It is very tough to get better when you are trying to demonstrate how ill you are."
Most veterans whom Frueh treats for PTSD are seeking disability compensation, he said. Veterans Affairs uses a sliding scale; veterans who are granted 100 percent disability status receive payments starting at around $2,300 a month. The VA inspector general's report found that benefit payments varied widely in states and said that was because VA centers in some states are more likely to grant veterans 100 percent disability.
Psychiatrist Sally Satel, who is affiliated with the conservative American Enterprise Institute, said an underground network advises veterans where to go for the best chance of being declared disabled. The institute organized a recent meeting to discuss PTSD among veterans.
Once veterans are declared disabled, they retain that status indefinitely, Frueh and Satel said. The system creates an adversarial relationship between doctors and patients, in which veterans sometimes take legal action if doctors decline to diagnose PTSD, Frueh said. The clinician added that some patients who really need help never get it because they are unwilling to undergo the lengthy process of qualifying for disability benefits, which often requires them to repeatedly revisit the painful episodes they experienced.
The concern by Frueh and Satel about overdiagnosis and fraud -- what researchers call "false positives" -- has drawn the ire of veterans groups and many other mental health experts.
A far bigger problem is the many veterans who seek help but do not get it or who never seek help, a number of experts said. Studies have shown that large numbers of veterans with PTSD never seek treatment, possibly because of the stigma surrounding mental illness.
"There are periodic false positives, but there are also a lot of false negatives out there," said Terence M. Keane, one of the nation's best-known PTSD researchers, who cited a 1988 study on the numbers of veterans who do not get treatment. "Less than one-fourth of people with combat-related PTSD have used VA-related services."
Larry Scott, who runs the clearinghouse http://www.vawatchdog.org/ , said conservative groups are trying to cut VA disability programs by unfairly comparing them to welfare.
Compensating people for disabilities is a cost of war, he said: "Veterans benefits are like workmen's comp. You went to war. You were injured. Either your body or your mind was injured, and that prevents you from doing certain duties and you are compensated for that."
Scott said Veterans Affairs' objectives were made clear in the department's request to the Institute of Medicine for a $1.3 million study to review how PTSD is diagnosed and treated. Among other things, the department asked the institute -- a branch of the National Academies chartered by Congress to advise the government on science policy -- to review the American Psychiatric Association's criteria for diagnosing PTSD. Effectively, Scott said, Veterans Affairs was trying to get one scientific organization to second-guess another.
PTSD experts summoned to Philadelphia for the two-day internal "expert panel" meeting were asked to discuss "evidence regarding validity, reliability, and feasibility" of the department's PTSD assessment and treatment practices, according to an e-mail invitation obtained by The Washington Post. The goal, the e-mail added, is "to improve clinical exams used to help determine benefit payments for veterans with Post Traumatic Stress Disorder."
"What they are trying to do is figure out a way not to diagnose vets with PTSD," said Steve Robinson, executive director of the National Gulf War Resource Center, a veterans advocacy group. "It's like telling a patient with cancer, 'if we tell you, you don't have cancer, then you won't suffer from cancer.' "
Hogenson, the VA spokesman, said the department is not seeking to overturn the established psychiatric criteria for diagnosing PTSD.
"We are reviewing the utility and the objectivity of the criteria . . . and are commenting on the screening instruments used by VA," he said. "We want to make sure what we do for screening comports with the latest information out there."
===========================
By Shankar Vedantam
Washington Post Staff Writer-Tuesday, December 27, 2005
© 2005 The Washington Post Company
Subscribe to:
Posts (Atom)
