Deadline Artists – Edited by John Avlon, Jesse Angelo & Errol Louis

Do you have a favorite newspaper columnist whom you often read? Do you occasionally pass on a newspaper column that you have read to a friend? (or these days might it be a great blog?)Well, imagine if you had a chance to read some of the best columns that have been written over the past two hundred years. That is exactly what the editors of this book have offered us as they compiled what they believe are the best of the best. They did this by going to many sources and experts including some contemporary writers and asked them to suggest their favorites over the years. They divided the book into sections such as social issues, war, politics. humor, sports etc. Some columnists that may be familiar depending on your age are Nora Efron, Jimmy Breslin, Drew Pearson, Teddy Roosevelt and even Benjamin Franklin, Some of the chosen columnists are still writing such as Thomas Friedman.  You may know some of them as great authors and may not have realized that they started as newspaper writers such as Ernest Hemingway. Some of the pieces are classics such as the famous column which is reprinted in many newspapers every year whch starts off- “ Yes Virginia, there is a Santa Claus.” There are works by legendary sportswriters such as Grantland Rice’s The Four Horsemen of the Apocalypse. There is  Ernie Pyle writing about the average soldier from the war front during WWII. Many of us read on the run or in-between things or a bit before we go to sleep. Since newspaper columns by their very nature are short pieces that you can digest as a little dessert. It also means that if  is there is a topic that is not your piece of cake or is so outdated that it no longer has meaning or interest (and there were a few in this category) you can just move on  to the next one. However, if you appreciate history in the making and are fascinated by social commentary of the times , don’t skip this book.

The President’s Club- by Nancy Gibbs and Michael Duffy

After a United States President leaves office he is invited into a secret club of former U.S. presidents where he is inducted into the group in an elaborate ceremony where allegiance to the current President is sworn with a special blood oath…Nope, actually there is no such thing. This is  just my fantasy. However the actual relationships of former US Presidents to each other and to the person in office is one of most fascinating stories that any political junkie could ever read. The documentation at the end of the book confirms that it is meticulously researched   and based on the reports of the people who were there including quite frequently the words of the Presidents themselves in their memoirs and other papers. Even when there were different recollections of interactions, both point of views were presented, making the study of the relationship even more interesting .

The authors are two seasoned political reporters, Nancy Gibbs and Michael Duffy both editors at Time Magazine frequently describe these often very personal interactions of these larger than life people as it were an official organization.  They have chosen to describe the “club activities” starting when Herbert Hoover left office. Hoover had received a humiliating defeat by FDR who had little use for Hoover after he took office. However when Harry Truman was faced with the problems of post WWII Europe, where there were millions of starving people and the US was sensing great competition with the Soviet Union, he felt he desperately needed help. He turned to Hoover who had great experience after WWI in organizing food distribution to a starving Europe. Hoover who had felt marginalized since he left office was nearly brought to tears when Truman brought him to the While house and asked for his help.

When a President has served the maximum two terms and a person of the opposing party wins the White House, it still means that the old President has to welcome the new guy into the White House usually following a bitter campaign. When the new guy has defeated the old guy, that can even be more difficult. All these variations were described in much detail as they took place.

When Truman stepped down, he had to welcome a Republican, whom he had campaigned against, into his new home. Of course Eisenhower, (Ike) was one of the most popular people in America. In fact, before Ike  identified himself as a Republican, Truman was hoping he would run as a Democrat. Harry even played with idea of running as his Vice- President. They subsequently didn’t get along so great all the time. These are some of the fascinating tidbits that emerge from each chapter of this book.

Although JFK died two years into his presidency, he of course interacted with a future president, Richard Nixon who was his bitter opponent in the 1960 election. Their personal feelings about each other are also reviewed in this book . Despite being of opposite parties, when JFK had to deal with a  proposed invasion of Cuba and then the failure of this invasion, who did he turn to as an adviser?  It was Eisenhower (not that he always listened to him).

Obviously when sitting Presidents phone ex- Presidents and ask for advice, it often is not for pubic consumption. When Lyndon Johnson found himself suddenly the President of the US after the assassination of JFK   he called the club members for advice, Hoover, Truman and Ike. So many behind the scene stories emerge which concern interactions as well as battles between Presidents, former presidents and even future presidents. While Johnson was finishing his  one and only elected term as President, peace talks were off and on in Viet Nam. Nixon was running against Humphrey and if peace looked good, it would be helpful for Humphrey and the Democrats.  Whereas if peace talks seem to be failing or were delayed it would be good for Nixon. It turns out that Nixon actually was doing a lot of behind the scenes shenanigans to cause the peace talks to be held up, much to Johnson and the Democrat’s disadvantage. This book tells it all.

Johnson when he left office was quite hurt that he hadn’t ended the war and that of course was the reason he decided not to seek a second term. Despite some of his personal negative feeling for the actions of Nixon, they had a great deal of respect for each other and it was quite meaningful when Nixon called upon LBJ for advice and some help. There was no doubt that when Nixon left office he was disgraced and humiliated after the Watergate scandal caused him to resign. His relationship with his successor Gerald Ford and Ford’s decision to offer Nixon a Presidential Pardon provides interesting insights into the thinking that goes into presidential decisions and how they are often made, despite the opinions of their advisers.

Nixon, once out of office spent the next 25 years attempting to rehabilitate his image. Which of the subsequent Presidents would you imagine treated him with the most respect and listened to his advice? It wasn’t Ford, Carter or senior Bush. It was Bill Clinton who early on  took the advice  of Nixon how to support Boris Yelsin in Russia and frequently discussed with him everything from foreign policy to the how he raised his daughter in the White House. This book supplies so many inside details about these relationships culled from numerous memoirs of the actual participants and their aides.

Reagan didn’t seem to utilize former Presidents as much as others did. However when Reagan went to visit a newly elected President Clinton he did offer an important piece of advice. He taught Clinton how to salute so he could respond properly to military salutes.. Also when Reagan had completed his second term and his protégé Vice President George H. Bush was running for President, he asked the advice of Richard Nixon how he could help his VP in the race against the Democrat Dukakis. Nixon of course had served as VP to Eisenhower and experienced how Ike hadn’t helped him enough in his run against JFK in 1960. Nixon gave Reagan detailed advice of what he should do and the he predicted that Bush will ask Reagan to campaign in California in the last two weeks of the election and that would make the difference. That is exactly what happened and Bush nosed out his opponent with the last minute undecided votes from California going to him to make the difference. Many observers believe that it  was  based on Reagan’s finest speech in the closing moments of  that campaign.

Carter was always a renegade of the club. When Clinton would call upon him to carry out a mission in North Korea, he would do a great job but then “go rogue” and call a press conference that would steam the current President. In the end, everyone  of the Presidents felt a great respect for the Presidency and the person holding the office. They all shared a unique experience  and the felt great empathy for the person in the job.

There were many surprising moments described in this book about the relationships between the Presidents. Perhaps the two most touching stories were between Father and son – George W President and his father. When George H visited his son George W in the oval office of the White House for the first time as President,  they were both speechless and cried.. Later on when the younger Bush sent a message to his father to tell him that he had committed the US to war, the elder Bush wrote him a personal note quoting the words of his daughter, the younger Bushes sister  who died of leukemia as a child ,“ I love you more than tongue can tell.”

Finally, there is the ongoing relationship that exists to day between the 2 Bushes and their formerly arch-enemy Bill Clinton. The elder Bush and Bill are particularly close and have worked together at Obama’s request to raise money and distribute it as well as food and supplies for several world wide humanitarian projects.  The three Bushes call each other by their presidential number. So when hanging out at a “Club” gathering perhaps at the Bush ranch in Texas, “43” would say “41 put some hot dogs on the fire, #42 is hungry.” That is how it really goes at the President’s Club. (2012)

If you are to read one book about the contemporary US socio-political and economic condition, That Used to Be Us is the book to read. The book is written by  Tom Friedman, the popular NY Times columnist and author and his good friend and colleague Michael Mandelbaum,  Professor and Director of American Foreign Policy  at the Johns Hopkins University School of Advanced School of Advanced International Studies who is also author or co-author of several important books. They have collaborated on a very well thought out analysis how the US is on the path to becoming a second rate country and how we can get back to the way we used to be.

The case is made that there are four essential new realities, which our country is now confronted:

1-      Globalization

2-      The IT Revolution

3-      The Nation’s budgetary  deficit

4-      The Pattern of Energy Use

Each of these issues is dissected and it is shown how we have failed to adequately deal with each of them. The authors analyzed why we have been unsuccessful but they also tried to delineated the pathway that the US could  follow back to greatness. Their style is one of facts and logic with numerous examples. They present their analysis with an empathic approach, which clearly comes from two people who clearly care about the country. While, I believe that they have  some political bias, the book is not written from an ideological viewpoint or with a particular political agenda.

They explain at this time of globalization and the IT revolution, it is essential that the country address education, infrastructure, immigration, research and development and appropriate regulations which controls each of this categories. The failure of the US to rebuild it’s infrastructure of roads, rails, schools etc. misses the opportunity to create sorely needed new jobs and the failure to recognize global warming is a missed opportunity to develop new green industries. The authors repeat a suggestion that Friedman has been making for years that an oil tax would be a significant step in making the US less dependent on foreign oil and would also facilitate the development of  a valuable alternate industry in the US. They explained that the budget deficit problem has to be understood by realizing that unemployment is remaining high even with the return of a great deal of the lost productivity. This is because of the IT revolution and the ability of computers and digitization to replace many old jobs. The authors make no bones about the absolute necessity of raising taxes and reducing entitlements in a bipartisan manner. They contrast the philosophy of the “Greatest Generation.” of saving  for the future and the “Baby Boomers who are borrowing from future generations.

This book is geared towards the future and therefore, the discussion of education was one it’s most important contributions in this comprehensive look at Problem America.

Starting off with the simple statistic that we have had zero job creations since 1999 and taking into account the nature of globalization and the IT revolution, it is no surprise that a good part of the solution is investing in education. This means valuing teachers, principals, and an education system which can not only produce students who score on world wide standardized tests but students who from an early age can learn how think innovatively and creatively. A wonderful example is given how teachers can be valued comes from Williams College. In preparation for their graduation their seniors nominate their best high school teachers. The nominees are then carefully vetted .The top twenty or so are chosen to be honored at the Williams graduation and partake in special seminars in their honor during graduation week. Other such programs are described which are examples how teachers and principals can be rewarded in intangible as well as monetary ways.

One of the things that makes this book so special is that there are not only many micro-examples such as this one but there are macro-examples as well as metaphors, stories from films, books and everyday life. There also is a concluding chapter about “shock therapy” which is a potential   political event, which if it happens  might just cause  the turning point that we need. You come away from reading this book with a feeling that the US is clearly in trouble but we have a 200-year history of pulling together to solve problems and of rising to the occasion to  achieve leadership and greatness in the world.  The book provides some well needed optimisms as to whether we can  become “the way that used to be us.”

Buy now on Amazon: My Life by Bill Clinton

I have always known that Bill Clinton  is a warm friendly guy but I never have had any personal contact with him- that is up until now. This autobiography makes you feel that he is sitting in your living room chatting with you. Chatting in some detail!! In addition to his obviously very good memory for faces, people and events he also met regularly during his presidency with a person who helped record an oral history which he was able to draw upon, as well as all appointment books and official papers, along with a staff to help him. But the product is still Bill talking away in great detail – often fascinating detail about the story of his life and story of the history that he made as President of the United States.

As he recounts his childhood and the early details of his life, he foreshadows his ability to connect with people and maintain them as friends. For example as a small kid maybe 5 or 6 years old in Arkansas there was a rich kid who lived across the street in a larger house . Bill was grateful that the boy’s parents and the kid were very friendly to him and invited him over to play. That kid was Mack McLarty who became his first White House Chief of Staff and one of his most trusted advisors. This story was played out time and time again as for example several of his college buddies who he met at Georgetown some of whom he met because they lived near him in his dormitory freshman year, were appointed to responsible jobs in his administration and were very special to him. Hence,  the informal designation FOB – friends of Bill. While I don’t recall it was used in the book, it is certainly is a category which includes many people.. Clinton’s ability to relate, tied together with a tremendous memory, especially for people, was a great political asset. When he was running for Governor he would travel throughout the state and meet many people from all walks of life often in small towns, in diners, gas stations and sometimes in their homes. He would personally come to understand their special story along with  their hopes and aspirations. When running for President about 20 years later he recognized these people on the campaign trail and reconnected with them. Of course there was no one in his early life that he felt closer to than his mother and his brother. His biological father had died before he was born.

Obviously he is a very bright guy who made it into Yale Law School and yet could skip some of classes in his freshman year so he could take on local responsibilities as part of the Democratic Party presidential campaign of that time

Clinton’s determination and ambition were demonstrated early in his political career. He rose quickly from Attorney General of Arkansas to Governor but was defeated in his quest for a second term . Hence the “ Come Back Kid “ as he then bounced back and was elected Governor’s for another two terms. The details of who encouraged him, who he emulated and how he conceptualized himself as a political person but yet as a person who really wanted to do things for people is all spelled out in great detail as you go on this journey with him through this book.

Reading this book is also like thumbing through an old family photo album and seeing people you know well as adults, but viewing them as young people just getting started.

His version of his encounter and relationship with Hillary comes across as a good friend who might be telling you about the details of the courtship with his wife. We come to appreciate the decisions that Hillary made to be with Bill and support him, long before she knew he might have such momentous success and the opportunities that would open up for her  We meet George Stephanopoulos as a young untested campaign worker and of course we know how he ultimately became one of Clinton’s  most trusted advisors and now is national network commentator. This story is repeated for so many familiar people.

Some critics have suggested that this book may be a little too long. But the fascination of this young man who grew up to be a two term President is in the details, It is the behind the scenes discussions, strategies, encountering dirty politics around him, the excitement of coming from behind, the election evenings, crisis in the White House and so much more, is what makes this book so valuable.

What also comes across in this book is Clinton’s genuine feelings for the oppressed and his desire to help people who can’t help themselves or those who are treated unfairly. His views of civil rights clearly come form his childhood and early experiences which allowed him to appreciate the prejudices which so many blacks in his southern rural area were experiencing and which he saw as wrong. As President, when he developed programs which were going to help downtrodden people, he was constantly relating them to people he knew and could name. This was quite consistent and very impressive.

Clinton’s early propensity for making and keeping friends is a recurrent theme throughout the book. Perhaps because he genuinely made good connections with people, he didn’t seem to question, as his career progressed, that famous celebrities, titans of industry and leaders of other countries valued his friendship because he was the most famous and powerful person in the world. He seems to take for it granted that the Prime Minister of Great Britain, the leader of the Russia, Princes and Kings were his good friends and that during and after his term in office he and Hillary would have dinner with them as one might be getting together with an old college buddy (which Clinton would also do). A most illustrative example of how he perhaps had a slight blind spot in this regard, is the story of Barbra Streisand and his mother. His mother was a great fan of this iconic singer. Therefore during the campaign, Clinton was thrilled when he could introduce his mother to Streisand. He then goes on to say they got along very well, became “very good friends” and they spoke weekly on the phone for many years??

Clinton knew if he were going to write a meaningful autobiography he was going to have to write about his sexual lapses, his impeachment and how he avoided having to step down as President. He acknowledged making a great mistake in his interactions with Monica Lewinski, a White House intern, and how he tried to avoid publicly acknowledging it. He related some of the details how he dealt this his wife and daughter in the face of this great humiliation. He shared how he was forced to sleep on the couch as Hillary came to grips with what he had done. However he goes into great detail of how he believes the Special Prosecutor Ken Starr over stepped his bounds and his authorization in trying to bring down the Clintons, first for Whitewater (accusations which were never proved of impropriety related to Hillary’s work with her law firm in Arkansas) and then extending his attacks against Clinton and trying to get information which would allow Congress to remove him from the presidency. He documents in some details what he believes were very unfair and untrue accusations, which were knowingly made by Starr against him, and how people who were his friends were badly treated because they would not misrepresent the truth. This segment of his biography will someday make a great documentary, movie, book, TV program etc.

Clinton had an opportunity to be president during a relative period of prosperity perhaps in part because of his policies. He was able to balance the budget (can you imagine that?) and sign into law quite remarkable legislation impacting our environment, healthcare

and social change. He spells them out and you can feel his passion and how proud he was of these accomplishments. He also recounts in great details what could have been perhaps his greatest accomplishment but yet fell short through no fault of his own. That was peace in the Middle East. He personally worked very hard with both sides and in the end had a solution which the Israelis could accept and many of the Arab nations including many Palestinians thought was fair but for some indefinable reason Arafat was not able to sign. Years later when Arafat wanted to sign on to these same things, the pendulum had past and the opportunity was lost (at least for then) .

The epilogue and any perusal of modern current events will reveal that Clinton has put his energies, his ability to raise money and his brilliance all in the service of humanity as he continues with trying to develop educational opportunities, provide  treatment of AIDS and promote social change throughout the world. .

It is well known that one of the ways to go down in history is to write the history. That certainly is what  a President who writes an autobiography is doing. Time will tell whether Clinton was as great a president. Despite his human foibles he has presented himself and the history of his life as a wonderful model for young Americans who want to make a difference in public service. His energy, sprit and caring for others is also a life lesson which we only hope might be contagious to many of the readers of his book..

Buy now on Amazon: Postcards from Tomorrow Square

This book consists of 12 chapters which were written between 2006-and 2008 when Fallows and his wife were living first in Shanghai and then Beijing and were traveling through many other part of China. I read it just prior  to our trip to China. Fallows was writing for the Atlantic Monthly and is considered by many people as the chronicler of  life in contemporary China – at least to many American readers. Although he does not speak Chinese he works as a good reporter who has lots of friends and contacts and does seem to get close to the people. He also arranges interviews with interesting, some important and many typical people in various situations and locations. It becomes clear that China does not speak with one voice nor can it be easily characterized. The difference between life in the cities and life in the rural poverty stricken western part of the country is well described. The book clarified as best as one might, the complicated relationship between the Communist government on a national level and the local government officials as they impact life in this vast country. And vast it is . It is the size of the country and the 1.5 billion people that also makes this land and  it’s people such an important force in the world. The freedom or lack of it to communicate in public or on the Internet, farming in the countryside, the growth of factories and manufacturing, how America out sources such to China, the failure and minor successes of trying to become green and deal with the environment, preparing for the 200 Olympics are some of the issues which this book explored. The author is very conscious of how Americans are trying to figure out China and whether to be fearful or embrace this country as we move into the 21^st century. This book doesn’t fully answer the question but it is a good primer on this subject.

A Journey Between China’s Past and Present. Oracle Bones

491 pp. HarperCollins Publishers. $26.95.  (2006)

Peter Hessler is an American who joined the Peace Corps and was assigned to China in 1996. After his rotation there is decided to live in China for awhile and took a position teaching English.  He has mastered the Chinese language himself and was able to speak  quite well. He developed good relationships with his students and he continued to communicate with them over the next several years, often visiting them as they made their way exploring various jobs and careers. Hessler then began to travel around China himself working as a free lance journalist and eventually taking a position as the Beijing correspondent of New Yorker magazine . This book covers a time period of of 1999 to 2002. I read this book in 2010 just prior to visiting China. I get the impression from this book and others that I have recently read , that China is in such rapid transition that some of the depictions even in this book must be viewed as historical .

The title of this book comes from the fact that the earliest Chinese writings were on the shells and bones of ancient tortoises. Hesler does focus on archeology for much of the book as the story of China does seem to be that of a vast country which has been searching to understand it’s complicated history and to understand where it has fit Into the scheme of the world in the past and what will the role of China be in the future. The migration pattern within the country in the past as well as in the present as illustrated by the lives of his young students with whom he tries to keep track. Their stories and the stories of their families are ones of seeking opportunity escape from poverty It should be clear to people who understand China and it certainly emerges from this book, that there are quite diverse ethnic groups in China. Hessler’s friendship with Polat a Uighur from what was East Turkestan is one such illustration. Polat’s success as a currency trader especially with the Russians is very interesting as is his decision to do a little deception ( as everyone seems to do ) and arrange to move to the United States.

American readers such as this reviewer have been interested in trying to understand the Chinese political system which on one hand encourages private business  but is an repressive dictatorial regime at least some of the time. Some of the times are illustrated what happened in Tiammenan Square and what happens periodically when various dissident groups try to demonstrate or speak out against the government. One case in point is the life and death of Chen Mangjia,  apparently a brilliant archeologist who end up killing himself. Hessler becomes very interested in understanding this man and what happened to him. While he never quite figures everything out, his quest to understand Mangjia’s life leads to him to meet and speak with many people . His writing about this man  is revealing about China. For example Mangjia apparently thought that China should stick with it’s traditional writing characters at a time that the government was considering a change to a more western style of writing ( which was never instituted ).  Nevertheless, Mangjia was labeled a “rightest” by the government and was actually sent away for several years to be “educated“ He may not have been the same again and apparently committed suicide.

The book ends prior to the 2008 Olympics which ended up being held in Beijing. The efforts of the country to get the Olympics to China were monumental as was the preparation for it. This book touches on the journey that China underwent and the potential impact expected form having the games.

I wish that I had thought to have a map of China handy as I read this book. Unless you are fairly familiar with the geography of this gigantic country and know where the various cities and regions are located, it can be a little confusing . Howeve this should be easy to remedy with a good map nearby.

Peter Hellser has made it very easy to share the several years of his life which he devoted to exploring and trying to understand China..The process of doing this allows the reader to begin to appreciate this vast dynamic land.

The following is a book review that I wrote which was published in the Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry. It is followed by a brief Q & A with the author.

UNHINGED  Daniel J. Carlat, M.D. Free Press 255 pages 2010

Dan Carlat, in addition to practicing psychiatry, writing his popular newsletter and blog, editing a series of psychiatry books for Lippincott/Klowers (one of which I co-authored) and writing monthly blogs for Psychiatric Times periodically (as do I)   has written expose pieces about psychiatry for the N.Y Times and other widely circulated publications. He has spoken out about the influence of the pharmaceutical industry on the practice of psychiatry and particularly the large amount of money earned by psychiatrists from the drug companies  often without disclosures. This latter point has been considered to have  ethical and legal ramifications. Knowing this background, I eagerly approached the opportunity to review his new book Unhinged  published by Free Press    (2010) and given a subtitle of  “The Trouble with Psychiatry-A Doctor’s Revelations about a Profession in Crisis.”

Early in the book, Dr. Carlat shared his own experience as a practicing psychiatrist where he specialized in prescribing medications and referred patients in need of talk therapy to a “psychotherapist.” He expressed his view “that most people are under the misconception that an appointment with a psychiatrist will involve counseling, probing questions and digging into the psychological meaning of one’s distress.” He goes on to site data which shows that 1 out of 10 psychiatrists offer therapy to all their patients. (I am not sure if this is a valid point since some patients clearly don’t need or want psychotherapy.) He then talks about the well known income differential which favors providing psychopharmacology treatment over psychotherapy. He provides a case history where he did not tell a patient that psychotherapy might work just as well as medication. He said that he decided upon medication because he received little training in  psychotherapy during his three years of psychiatry residency (Mass General) and that he “ doesn’t do psychotherapy  because “I can’t do psychotherapy.” One of the themes of this book is Carlat’s odyssey to ultimately deciding to learn more about psychotherapy and follow a mode of his father who is a psychiatrist and develop a practice which combines psychopharmacology and psychotherapy even if he doesn’t make quite as much income as he did in the past. He shares the interactions with colleagues, teachers and mentors as well as patient vignettes, which lead him to this decision.

This book also examines other controversial issues. For example, Dr. Carlat discusses DSM which he calls “ The Bible of Psychiatry.” He believes that the tradition of psychological curiosity has been dying a gradual death and that DSM is in part the cause and the consequence of this transformation of our profession. He argues that as a result psychiatrists are less interested in “why” and more interested in “what”. (I thought that psychiatrists could chew gum and do other things at the same time. If we continue to use and refine it, DSM allows us to communicate better, do research and get paid.) Carlat interviewed both Bob Spitzer and Alan Francis, the leaders of DSM III and IV respectively who are  both quite critical of the emerging DSMV.

Not surprising, knowing of the previous writings of the author, a good part of the book dealt with the relationship between psychiatry and the pharmaceutical industry starting off with a chapter on “How Medication Became the New Therapy.” There is a  description of the evolution of various drugs used  in psychiatric  practice including the story of Prozac as well as examples of how and why new drugs are introduced as patents on old ones expire. While most of these stories are fairly well known to psychiatrists, it may be surprising to see the behind the scenes descriptions of how side effects such as sexual dysfunction and suicidality were initially minimized and ultimately handled.

The chapter on “How Companies Sell Psychiatrists on their Drugs” reflects some of the writing that Carlat has made in the popular media. He personalizes this important topic by describing his own  previous  relationship with various pharmaceutical representatives. He also reveals the fact that drug representatives have access to each doctors’ prescribing pattern before they visit him or her. He discusses how friendliness and  bringing little gifts such as books or one’s favorite Starbucks coffee have played a subtle but distinct influence on doctors and their prescribing habits. (There have been recent restrictions on these practices.)

Dr. Carlat also outlines his own experience of being a “hired gun” where he gave paid talks to primary care doctors and psychiatrists earning as much as $30,000 in one year. He told how he and his wife were flown to NY and stayed at luxurious hotels and ate in fine restaurants paid for by the pharmaceutical firm for which he was a speaker. He eventually decided that this was morally wrong and stopped this practice. He did go on to write about other psychiatrists whom he reports have made millions of dollars and in some cases were also receiving research grants.  He told  how they were not reporting to their universities, the income that they were receiving which was required. He details Iowa Senator Grassley’s investigations into very well known psychiatrists. He raises ethical questions about doctors taking pharmaceutical money while promoting off label use of various medications for treatment of ADHD and bipolar disorders in children.

There is a discussion of what Carlat calls “the seduction of technology”, specifically referring to the promotion of Vagal Nerve Stimulation and Trans Magnetic Stimulation.    (I observed how the latter technique was actively being promoted at the recent APA Meeting in New Orleans).  Interestingly, Carlat concludes this chapter with a statement that “psychiatrists  need to reacquaint themselves with the missing skill of psychotherapy.”

Perhaps one of the most interesting and controversial thesis of this book is the author’s conclusion that “medical school is the wrong place to train psychiatrists.” He believes that there should be programs that integrate psychopharmacology and psychological technique from the beginning of the training of psychologists . He goes on to say that  psychologists should ultimately prescribe medication as well as do psychotherapy. He describes one experimental model that was briefly used in the 1970s  at  a teaching institution in California but failed to be accepted as a model for licensed care. .

Whether or not you  agree with the arguments, analysis or conclusions of Dr. Carlat, there is no doubt that he has written a very thought provoking book that is based on his own experience with a reasonable attempt at documenting many of his statements. (There are 16 pages of notes and references).  His discovery of psychotherapy as a valid form of treatment will not surprise many of the readers of the journal where this review is appearing. His idea that that psychiatry at this time is troubled and in crisis is probably best judged by a longer historical view. However I suspect that this book will be used by historians to reflect some of thinking of the time as will be  another book written by the psychiatrist Peter Kramer  which came out  17 years ago titled Listening to Prozac . In the meantime Dr. Carlat’s views are out there for discussion and debate.

Take Five With the Author

Following are the answers to five questions I recently asked Dr. Carlat for this blog:

Dr B: Can you describe the reaction of your colleagues to this book?

Dr. C: The reaction from colleagues has been mixed. Most have agreed with the central idea, which is that psychiatry has moved too far into psychopharmacology and has largely abandoned therapy. Many have disagreed with my fairly radical proposals, such as creating an entirely new training system that would be an alternative to medical school and residency. And of course, some have become positively apoplectic at the idea that psychologists can prescribe from a limited formulary safely. So I’ve had my share of fan mail and hate mail.

Dr. B: Do you believe that at present there is enough transparency about possible conflicts of interest in national presentations at meetings and in journal articles?

Dr. C: No, all we get is the name of the company. We don’t get the amount of money, nor the name of the product that the presenter has promoted. These pieces of information are critical for the audience to judge the likelihood that money is affecting the accuracy of a presentation.

Dr. B: Do you have any ideas how the new healthcare legislation (Obamacare) will impact on the practice of psychiatry ?

Dr. C:It will increase the demand for psychiatrists, simply because we will be adding about 30 million people to the health insurance rolls. Some have argued that the emphasis on gate-keepers and accountable care organizations will take business away from psychiatrists, but I can’t imagine PCPs have either the time, interest, or expertise to deal with our patients.

Dr.B: Do you see psychotherapy by psychiatrists being viable in over the next 5- 10 years.?

Dr.C: Not unless psychiatrists are willing to take a drastic pay cut. There’s way of prettying this one up. Insurance companies are never going to pay nearly as much for an hour of therapy as for 3 or 4 psychopharm visits. So the more therapy you choose to do, the less money you will make in direct proportion. That’s assuming, of course, that you are taking insurance. As many as a third of psychiatrists have opted out of insurance and charge their regular fees for therapy, much higher than what they get reimbursed by insurance. Personally, I don’t think that’s a viable option from the standpoint of ethics and health care policy. And it’s demeaning to us. We’re saying, essentially, “our skills are not valuable enough for your health insurance to pay what we think we’re worth, so we don’t take insurance.” I’m not one of those who villainizes insurance companies, partly because many of my trusted psychiatrist colleagues work for insurance companies, and I know what they are up against. They make a serious attempt to come up with a fair market price for therapy, and they have found no compelling empirical evidence to suggest that a psychiatrists’ therapy session is worth double a social workers’.

Dr. B: Can you tell us about any new books or projects with which you are involved?

Dr. C: I am just extremely busy managing my publishing business right now. I wish I had time to write another book, but I have nothing in the wings.

The Audacity to Win: The Inside Story and Lessons of Barack Obama’s Historic Victory by David Plouffe

Newly elected President Barack Obama encouraged his 41 year old campaign manager to write this book and tell the story of his presidential campaign which two years previously was quite improbable. It is the story of Barack Obama, a newly elected US Senator who and his close brilliant political advisor David Axelrod who brought in his junior partner to join their team and ultimately take the reigns of one of the most remarkable political campaigns in modern history.

Axelrod and Plouffe with perhaps several other close senior members of their team such as Ed Gibbss who became Obama’s Press Secretary put together a smooth running campaign machine which built an Internet network of millions of dedicated volunteers and contributors, the like of which has never been seen before. This certainly dwarfed the short lived Howard Dean Internet campaign of several years previously as well as that of any of his primary opponents or that of John McCain.

While the size ( in both persons and amount of money raised ) was quite unique, it was the free flowing frequent communications to this network, the discipline to stay on message and the confidence in their clear electoral strategy which probably best characterized the ingredients which made them so successful. They were experienced people who knew that they could not allow any leaks to the press and that they had to do their own polling and focus groups, which they did quite frequently. They paid meticulous attention to detail as professionals should do and they had intense prolonged daily conversations among their small group which of course included the candidate himself. Plouffe described the importance of these evening conversations where the every twist and turn of the campaign was analyzed and discussed usually among a very small group.

Of course the victor writes the history which will most likely stand as the record. The story does ring true and is consistent with what we know happened. The should be no contesting the information of how the troops were deployed and the money spent as that is on the record. Obama’s two major opponents Hillary Clinton in the primary and John McCain are for the most part treated and described with mostly respect and admiration. However their campaigns are at times depicted as inept , making blunders and miscalculations. Mark Penn one of Hillary’s most important advisor is shown particularly as making major mistakes.

Since Plouffe was so close to the candidate a and family during the campaign does seem to be some insight into the character and sincerity of belief of both Obama and his wife Michelle. Both candidate and campaign manager came across as caring people who loved their families deeply but accepted the necessary rigors of the campaign because they really believed that Obama had something special to offer which country needed at this time.

One of the most memorable lines in the book was at the time that the Reverend Wright inflammatory remarks became a factor in the campaign. It was at this time , the campaign advisors changed their previous position that it was not necessary for Obama the first black candidate to talk in any depth about race. Obama wanted to give an in depth speech about race and what it meant to be a black American running for President. He also felt he had to do the major writing of the speech. However there was little time to prepare and this major address. Plouffe recalls asking Obama if he felt he could pull it off. Obama relied , “ Don’t worry I have writing this speech for the past 30 years”

The book clearly spells out so many of the nuances of their strategy both in hard fought primary against Hillary Clinton and then the election campaign against John McCain. Each phase was mapped out in advance in a very thoughtful manner. IN the primary it was essential that they win Iowa which was the first and most important by their standards in order to get them clearly in the ballgame. They brought in a army of volunteers as well as mobilizing young people in the state. Similarly in the actual election campaign, the strategy was to win every state that Kerry had won in his previous unsuccessful election bid 4 years ago as well as specific additional electoral votes from states in which they thought they would stand a chance of winning in order to needed to bring them over the 270 mark was worked out in great detail. They left no detail unplanned. In fact they had several scenarios, which were determined to achieve so guarantee victory. How they conceptualized each subsequent state and how they calculated every convention delegate and ultimately the super delegates and then each block of electoral votes was a work of art or at least a work of political genius. For example , Nebraska is a rare state that divides its electoral votes. Plouffe calculated that Nebraska would go Republican except one small area in the state labeled Nebraska 2. Therefore this area was specifically targeted. And funds and volunteers were funneled into this one part of the state Although ultimately it was not needed for the landslide victory on election nite, the campaign Plouffe got great satisfaction in winning Nebraska.

Funding was essential in order to support their staff , Internet operation and to buy expensive TV adds and arrange events in each of the states. They made a very difficult decision NOT to accept federal funding which would have been something like 85 million dollars. Instead they would forgo that and try to raise even more than that amount through their Internet campaign mostly from small contributions. They ultimately achieved about twice that amount and the decision paid off for them. However it was a difficult one to make since they had initially made statements that they favored public funding of presidential campaigns If you accept federal funding you can’t accept additional funding so your supporters rather than give to the candidate would then give money to the Democratic National Committee ( DNC) or the Republican RNC in the case of McCain. . These entities then function as an Independent Expenditure and are not allowed by federal law to communicate with the candidate about strategy or coordinate their efforts so they mount an independent campaign plan. So in the end McCain who accepted federal funding had 85 million from them and the RNC raised 250 million which they could spend without coordination with McCain’s campaign.. Obama by not accepting federal fund could raise as much as they could (with the usual limitations of 2300 from individuals. Obama raised at least 450,000 million for his campaign since he did not accept federal funding. The DNC raised less than half that amount which they could spend for him but not with his coordination. So Obama out raised McCain by a significant amount and could much better coordinate the strategy and spending.

The Obama campaign from the very beginning made decision on what seemed best for Obama and was less influenced by what things cost. For example they spent the money to utilize Mile High Stadium so he could accept the nomination in a larger and more dramatic venue. At the conclusion of the campaign they bought air time for a 30 minutes speech to the American People about the economy and other significant issues rather than short less substantial advertisements. Most of the time money was no object for them

Plouffe is deservedly proud of how he set up and coordinated his close to five million volunteers. Not only could he repeatedly go back to them for contributions which they responded but he utilized them to get across any message that was needed at whenever it was needed. He communicated with his net work on a almost daily basis which means he could provide speaking points on any issue that came up. This mean t that there could be an immediate response to any question raised and the network of people would be speaking to their neighbors and co-workers the next day on message . The volunteers appreciated being kept in the loop and were very responsive when they were asked to knock on doors, write letters, make phone calls or even give more money.

In the end it was a real grassroots campaign and the Internet was the soil in which it grew. It was conceptualized by a team led by a brilliant young man who shared his boss’s vision and with odds against them in the starting gate but i they had the audacity to win.