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El Cajon Locksmith - Lock & Key El Cajon, CA
Did you know that in over 40 percent of all home robberies the point of entry is the front door? This statistic is just an indicator of how badly many home owners fail at securing their property against intruders – seeing as we're talking about the primary entryway that should ideally be the hardest point for thieves to crack but has instead become the entryway of choice for them. El Cajon Locksmith is a professional locksmith in El Cajon, CA area that you can turn to if you want heightened security at your home or business property. We can set you up with high-security locks that are very resistant to external manipulation and have impossible-to-duplicate keys. Aside from acting as security experts, you can contact us for lightning-quick assistance whenever you have a regular lock-related problem or request. We can repair your locking systems, make you new keys and handle lock outs. We are you're a one-stop source for home, automotive, and business locksmithing needs.
All In-Inclusive Key Cutting Services
We can copy keys for your home, business, your vehicle, or for items inside your property. Some of the most popular kind of keys we are asked to cut include:
- Transponder car keys: You don't have to call your car dealer if you need replacement smart car keys. We can program new ones for you affordably.
- Car keys with remotes: Do you need new car keys with a remote attached to it? Or, perhaps, you need a new remote for your old key? We can supply you with both.
- Standard car keys: Looking for a service that can copy ordinary car keys (for old models)? Call us!
- Keys for regular mechanical locks: We can also make you new keys for all popular mechanical lock types.
Locked Out of Your Home, Car, or Commercial Property? Not Anymore!
Being locked out of your property might leave you panicked or frustrated, especially if you're on a tight schedule. We have the experience and the tools to handle lockouts quickly and easily, though. We can:
- Open home, car, and business doors: We can get most doors open without too much trouble, even if you have a state-of-the-art alarm system that's getting in the way. We cause zero damage to your property, if we can at all help it.
- Unlock locked car trunks: Did your trunk jam shut, get bent out of shape, or did you lose the key to its lock? We can open your trunk for you with the help of our tools. We will also rekey or replace the lock on it.
- Open safes: Some of our clients forget the combination to their safe. If you want your safe open without damage being caused to the contents inside it, you can contact us.
- Open file cabinets: Want your file cabinets opened quickly? We can do it for you. We also replace or rekey file cabinet lock.
We Make Your Property Secure by Installing High-Security Locks:
There are three main grades of locks:
- Grade 1: Grade 1 locks – both residential and commercial - provide a maximum level of protection from external threats. These locks are very highly resistant to forced entry and should ideally be installed on front door and other exterior-facing locations (like garage doors).
- Grade 2: Grade 2 variants are not as secure as the Grade 1 ones, but they can still take a beating. We recommend you use these locks inside your property. They are less expensive than Grade 1 locks.
- Grade 3: These can be used inside your home or business property for securing low-risk items or areas. These types of locks are generally very cheap.
We provide both electronic and mechanical versions. Electronic locks, if you're worried about their effectiveness, provide as much safety as mechanical ones, but they are usually the more expensive option. We source our products from well-known, reputed names like Kwikset, Falcon, Mul-T-Lock, and Schlage.
Rekey for Better Access Control
Have you had a falling out with an employee, spouse, tenant, or anyone else that has access to your property? Or, perhaps, did you lose your keys? We recommend you go for our re-keying service in all these cases. We can:
- Re-key locks individually: We can make your old keys obsolete by replacing the inner mechanism of your locking systems individually, so that they will work with a new set of keys.
- Make you a master key system: Do you want to be able to open all the doors on your home or business property with a single master key? We can convert your existing locks into a master key system, if they support the procedure.
Having Trouble Choosing the Lock? Consult With Us Free!
There are so many kinds of locks in the market that it's a big challenge to pick the right one for your home or commercial buildings. We offer free consultations for home and business owners – our locksmiths can survey your property, once you contact us, and generate a list of recommendations on the kind of locks that would best suit your unique building. We have consulted for countless clients over the years – you can rely on us to choose the best security setup for you, so you can sleep better at night knowing your family and possessions are safe from external threats.
El Cajon Locksmith has been in business in El Cajon, CA for close to a decade. Our service is very popular with the community and we are known as a dependable, reliable locksmith that residents can contact during times of lock-related trouble. We endeavor to provide a high level of workmanship for our customers and we only carry the best products in the market. Our team is well-trained, polite, and professional. We aren't in this to make a quick buck. Instead, we want to exceed our customer's expectations and build a long-term, mutually beneficial relationship with them. You can rely on our service to be there when you need it the most; we are available all day, every day (including major holidays) and we don't charge extra for emergency services.
Why Pick El Cajon Locksmith to Be Your Go-To Locksmith?
- 24-Hour Emergency Service: Our service is available round the clock. You can call us in the afternoon or the middle of the night, and we'll respond just as quickly.
- Mobile Locksmith: Our mobile vans can reach all areas of El Cajon, CA in a short span of time. We can reach most popular destinations in a matter of minutes.
- Experienced team: We employ knowledgeable, experienced professionals that have little trouble dealing with requests on-site.
- Easy On Your Wallet: Our services are priced very affordably and we have locks for budgets big and small. We won't overcharge you during emergencies or if you need night work done.
Hire the best locksmiths in the region by dialing 619-213-1456
We Provide Lock & Key in the following zip codes.
Things To Check / Ask When You Calling To Request A Locksmith
- No extra cost for holidays and weekend
- Prompt and Responsive Locksmith
- Courteous Customer Agents
- Reliable and Responsive Locksmith Services
- Customer Satisfaction at its Finest
- If they have Warranty on the job & parts
- If the Locksmith is a local company
- If the Locksmith License Bonded & insured
- If the Locksmith available 24 Hours
- If Locksmith provide same day service
- If Locksmith doing a Free Quotation
- If Locksmith provide Emergency Service
Contact us
Google Map
Get in touch
El Cajon Locksmith


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Not an ACS Member?
Join the world's largest society for chemical professionals.
Stay up-to-date on the latest scientific and technical information with individual subscriptions to ACS journals and a free subscription to the weekly Chemical & Engineering News magazine. Take charge of your career with continuing education opportunities. Network with your peers through discipline-specific technical divisions and local sections. Members have access to career services such as the ACS Careers Jobs Database, resume reviews, and the salary comparator.
ACS welcomes members from across the globe. Join the ACS community today and enjoy the benefits of membership.
Join ACS

subset: commoncrawl


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PR-OLF390 Overlay Filler
- PR-OLF390 Overlay Filler
- It has the best quality with an affordable price.
- This style in Brown color is elegant and durable.
- This item will fit your renovation project with dimension of 2 1/2″ Width x 84 3/4″ Height x 3/4″ Depth
- Other Specs:
- 3/4″ Solid wood
- Outer profle matches door style
- Mounted to wall fller, base fller, or column boxes. Fillers sold separately.
- Actual size 2-1/2″w x 84-3/4″h x 3/4″d
- Other Specs:
- Certifications:
- Carb2 Compliant Certification.
- Green Guard Gold Certification. Certified for low chemical emission.
- Manufacturer Warranty Period: 5 Years (*Painted finishes 2 Years)
- Category of this item: Kitchen Cabinets Fillers Overlay Fillers
The Petit Brown collection features a clean, simple design that pairs wells with any layout or color scheme, and is adaptable enough for use in both traditional and modern homes. Available in a variety of colors, this collection produces a dramatic, contemporary twist to a classic shaker design.
Petit Brown cabinets can make any kitchen look larger and brighter. Its clean and simple design pairs well with any layout or color scheme, and is adaptable enough for use in both traditional and modern homes.
Petit Brown brings together a color and design combination that has transcended every kitchen trend.
PR-OLF390 Overlay Filler
Forevermark Cabinetry stands as your premier destination for high-quality in-stock cabinets, boasting an extensive selection of 18 distinct door styles to cater to every taste and home decor. Among our standout offerings is the PR-OLF390 Overlay Filler, renowned for its exceptional craftsmanship and versatility.
The PR-OLF390 Overlay Filler is designed with soft-close hinges, full-height doors, and full-extension drawers, ensuring smooth and silent operation while maximizing storage space and accessibility in your kitchen or bathroom. With these premium specifications, you can enjoy the convenience and functionality of your cabinetry for years to come.
At Forevermark Cabinetry, we prioritize customer satisfaction and peace of mind. Each of our cabinets, including the PR-OLF390 Overlay Filler, comes with a comprehensive warranty, providing protection against any manufacturing defects. Additionally, our fast shipment options ensure that you receive your cabinets promptly, allowing you to start enjoying your newly transformed space without delay.
We understand the importance of affordability without compromising on quality. That's why we offer our top-tier products like the PR-OLF390 Overlay Filler at competitive prices, making it easier than ever for homeowners to achieve their dream home within their budget.
But our dedication to customer satisfaction doesn't stop there. For those seeking even more customization options, we offer a semi-custom cabinet line featuring the PR-OLF390 Overlay Filler. With an extensive selection of colors and materials to choose from, you can tailor your cabinetry to perfectly complement your home decor and personal style.
Experience the unparalleled combination of quality, affordability, and customization options that Forevermark Cabinetry has to offer. Elevate your home with Forevermark Cabinetry today and discover why we're the trusted choice for homeowners nationwide.
For more information about our certifications and warranty, please visit our website:
Certifications: https://forevermarkcabinetry.com/resources/certifications/
Warranty: https://forevermarkcabinetry.com/resources/warranty/
With Forevermark Cabinetry, your dream kitchen or bathroom is within reach.


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At Ray White Rural Pittsworth, we are always on the lookout for enthusiastic and professional candidates to join our team.
We believe that the reason Ray White Rural Pittsworth has been able to become as successful as it is today can be attributed to the constant recruitment of a balanced cross-section of experienced personnel as well as individuals starting out in the industry.
Our goal over the coming years is to keep expanding with the right people to consolidate our position in the marketplace as one of the leading offices within the area.
If you are considering a career in Real Estate or if you already have previous experience in the industry, we would be more than happy to speak to you about the prospect of joining our friendly team.
Please call the Ray White Rural Pittsworth Recruitment Officer on (07) 4693 1644.


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We put the "E" in EAA - the community of amateur aircraft builders!
Announce the first flight of your project here - share photos, inspire others, and let all of us help you celebrate!
First flight- Breezy N1879B
Use this control to limit the display of threads to those newer than the specified time frame.
Allows you to choose the data by which the thread list will be sorted.
Order threads in...
Note: when sorting by date, 'descending order' will show the newest results first.
Forum Rules


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箒 Houki Houki (Japanese broom)
A Houki is a broom traditionally used in Japan for sweeping trash and dust. There are two kinds of houki: zashiki-bouki (room broom) and niwa-bouki (garden broom), depending on where they are to be used.
Zashiki-bouki are generally made from hemp palm fibers and morokoshi ( millet- a kind of grain) fibers . The hemp-palm broom is more widely used in Western Japan and it is made from gathered "oni-ge" (demon hairs) which are extracted from hemp palm bark. The morokoshi plants used to make houki are harvested after growing for one year when they are about 2 meters high. The ears of the millet plants are threshed and dried in the sun for about a week. Then, high quality ears are selected and gathered for making houki.
Besides their obvious practical application as a cleaning tool, houki also figure in various traditional customs associated with the idea of "sweeping away".
There was a spell in which a houki was stood upside down when a host wished his guest to cut his long stay short and go home. In some areas, a houki was considered a guardian charm for the easy and healthy delivery of a baby. The houki was placed by the bedside of the pregnant woman and, once labor started, a light was attached to the houki and the woman prayed to it. Her belly was then caressed with the houki.
Houki were believed to be sacred and stepping it over or on them was avoided as it would incur divine punishment. Such customs still can be seen today all over Japan.
- name
- Houki (Japanese broom)


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Neon flex sign has 190 lumens of brightness enough to leave all its prospectors in amaze. The constant glow and radiant colors set up every event's mood, be it a Party, Wedding, Bar, or your Home; it will surely be the backdrop of every picture taken on the venue.
LED flex tubes don't emit heat or shatter easily, which may be the case with traditional neon glass signs. Its safety has increased its scope for broader use than just for commercial purposes. It can be a beautiful decor for your kid's room, work desk, birthday party, almost anywhere you want to have it.
LED neon light is an affordable option to light up every corner; you want to make it interesting. Beauty Salon Led Sign will continue to energize your place for more than 50,000 hours, consuming less electricity, significantly costing you less in the long run.


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Quebec police are looking into whether Saturday's train derailment and the massive explosions that followed in the small town of Lac-Megantic were caused by "foul play or criminal negligence," CBC News reported Wednesday morning.
"We are conducting a criminal investigation. We are not neglecting anything so far," provincial police inspector Michel Forget said, according to the news network. Authorities do not suspect this was an act of terrorism, however.
As Wednesday began, the confirmed number of deaths remained at 15. But as we reported Tuesday evening, that left the number of missing at about 35 people. (Update at 10:55 a.m. ET: Later Wednesday morning, officials said they now believe about 45 people are still unaccounted for.)
Update at 6:25 p.m. ET: Death Toll Rises
Authorities now say that at least 20 people died in the massive explosion. They're among the 50 people still counted as missing because they have yet to be identified, the CBC reports.
Our original post continues:
The CBC says that Canada's Transportation Safety Board is "looking into whether the train's operator — Montreal, Maine and Atlantic — followed proper safety procedures in the hours before the unmanned 72-car train carrying crude oil rolled down a hill and slammed into town. ... It remains unclear whether the train's conductor had set enough hand brakes — which are meant to hold a train in place even if the air brakes fail — before he left the train for a shift change shortly before the fire broke out."
The Canadian Press writes that "police say they're treating the Lac-Mégantic disaster area as a 'crime scene' and say they could lay charges. ... Quebec provincial police Insp. Michel Forget revealed that police are not leaning towards terrorism as a hypothesis, but are more likely exploring the possibility of criminal negligence. ... However, he did not say whether the investigation was for potential crimes committed at the explosion site or farther up the rail line."
Meanwhile, investigators are also looking at what happened earlier when there was a fire on the train as it was parked in the nearby town of Nantes. According to Canadian Press, the railroad company "has suggested the fire crew didn't do enough — and even suggested the decision to shut off the locomotive to put out [the] fire ... might have disabled the brakes. The fire crew, however, says it was simply following procedures set out by the railway itself."
It was following that fire, while the train was unattended during a shift change of its crew, that the tank cars loaded with oil started rolling toward Lac-Mégantic — where they derailed and exploded.
Lac-Mégantic is about 150 miles east of Montreal, near the border with Maine.
Copyright 2021 NPR. To see more, visit https://www.npr.org.


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If you are a registered user, please enter your email and password.
For more information, please see our Privacy Notice. California residents, see our California Privacy Notice and Do Not Sell My Personal Information page.
Make one now for faster checkout, access to sales and other great offers.
Be the first to know when this product is available.
Be the first to know when this size is available.


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Dolce & Gabbana Glasses
*Tracked Insured Royal Mail
*Tracked Insured Royal Mail
Posh Eyes is a leading online retailer of designer glasses and major brand contact lenses, based in Oxford, UK. Since the Company was founded in 2005, Posh Eyes has served over 25,000 customers in 30 countries, and has built a reputation for offering the best customer service of any online optical retailer. In 20 years in the optical industry, Managing Director, Julian Gooddy, has led teams which have won the top customer service awards in the UK, including the prestigious Daily Telegraph / Energis Customer Service Award.
Based in Oxford, UK with Professional UK Telephone Support
Try Before You Buy
Visit us in Oxford for Measurements, Fitting & Advice
Genuine, Authentic Branded Products
Staffed by fully qualified UK based Optician (30 years experience)
Call Us +44 (0)1865 400384
Fax +44 (0)1865 891322
Posh Eyes
Westbury House, 52 French Laurence Way, Chalgrove, Oxford OX44 7YF, United Kingdom.
Skype: posheyes
© 2014 Posh Eyes. All Rights Reserved.
Posh Eyes (A Division of EyeCare Services Ltd.)
Westbury House, 52 French Laurence Way, Chalgrove, Oxford OX44 7YF United Kingdom
® Posh Eyes and the Posh Eyes logo are registered trademarks. EyeCare Services Ltd. is Registered in England & Wales - Reg. No. 04501667 V.A.T. No. 805323264


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Are you a people person with a real passion for sales?
We're looking for an ambitious and confident Sales Consultant to join the team at our Motorstore/Vauxhall Branch in Perth.
What's the job?
You'll be known as a Product Consultant at Arnold Clark but your role will be heavily sales focused. Be sure though, this isn't any kind of sales job.
Forget suits, ties and devoting your entire life to the showroom floor. Instead, say hello to a car sales role that gives you permission to be yourself, showcase your amazing customer service skills and enjoy every working day to the full.
As an Arnold Clark Product Consultant, you'll be with our customers every step of the way – from the moment they walk through the door right through to offering them a great aftersales experience. This role is all about helping our customers find the right car based on what they need and building up strong, positive relationships with them through every step of the process.
From our comfortable uniforms and range of staff benefits to our five-day working week commission structure, we're giving you all the tools to succeed – and still enjoy your life outside work.
You also don't need to be a car fanatic to be a Product Consultant (although we like those, too!) All we ask is that you love helping people, have buckets of energy and enthusiasm and can rise to any challenges along the way.
Sound like you?
On an average day, you'll be…
The skills and qualities you need…
Arnold Clark is committed to creating a diverse and inclusive workplace. We strive to create an environment where collaboration, unique perspectives and multiple approaches are celebrated. We care about our employees and our communities, we nurture talent and encourage ambition, and we are passionate about people who take pride in their work. Our employees are at the heart of everything we do – diverse in our make-up, united in our goals.
To find out more about Life at Arnold Clark, visit our website.
If you think you're the right person for this fantastic opportunity, apply online now. We're looking forward to meeting you. Employment within the Arnold Clark Group is offered subject to satisfactory reference and disclosure check.
Every Arnold Clark employee is entitled to a wide range of benefits, including:


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Pink Clover Stud Earrings
- In stock, ready to ship
- Back in stock July 23, 2024
Lucky you! Get these unique Pink Clover Stud Earrings and add a bit of luck and style to your look. Featuring a stunning pink four leaf clover design in a rose gold tone, these earrings will have you looking fab and feeling blessed for years to come! 🍀
*Earrings are sold by a pair.
*Comes with a pair of 925 Sterling Silver Butterfly Earring Backs.
MATERIAL: 925 Sterling Silver
FINISHING: Rose gold plating
EARRING MEASUREMENT: 6mm x 6mm
- Fast Shipping from Kuala Lumpur
- 30 Days Quality Guarantee ( what's this? )
Free Polishing Cloth & Earrings Pouch
(max 1 set per order)
Hypoallergenic (Sensitive Ears Friendly)
Most people will have no reaction or issues with earrings made of 925 Sterling Silver.
Wear Comfortably For Hours or Even Days
Perfect for the ones who love to wear earrings most of the time, to work, travel or even sleep.
Water Resistant, Doesn't Rust
S925 Sterling Silver is an alloy of 92.5% Pure Silver & 7.5% Copper. It is 100% water resistant, however we recommend keeping it away from substance with high chemical content to keep earrings shining at its best longer.
To learn more about the materials we use, click here.
We offer two 0% interest easy payment options:
Grab Pay Later
Choose between paying in 4 monthly installments or the next month.
Atome Pay Later
Split payment into 3 monthly installments.
How to pay with these options?
After reaching iPay88 payment page, please look for the payment option dropdown menu and select GrabPay or BNPL Atome to proceed with your payment.
Dest. | Shipping Fee | Min. Purchase for Free Shipping | Shipping Timeline |
West Malaysia |
RM6.90 | RM120 | 1-3 work days |
East Malaysia |
RM18 | RM180 | 3-5 work days |
SG | RM30 | RM250 | 5-8 work days |
Can I wear the earrings to shower?
- We recommend taking off your earrings before shower to better preserve & prolong their lifespan.
- While water does not ruin sterling silver earrings, it wears off the shine / plating and speed up the tarnishing process.
- However, if you do wear them into shower, please ensure that you are using a pH neutral cleansing shampoo.
Easy ways to keep your earrings at its shiny best:
- Avoid direct exposure to any chemicals products, such as perfumes and lotions.
- Remove earrings before taking shower or swimming. Avoid contact with chlorine, sand and saltwater.
- Take them off before doing any exercise or physical activity to keep them away from extra knocks and sweat.
- Do not wear them to sleep to avoid accidental damage.
- Clean and polish them using a silver polishing cloth.
- Keep them in airtight jewelry bag or box and store them in a dry and cool place. Avoid extreme temperatures and direct sunlight.


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Cameron calls on EU to double Ebola funding
David Cameron has called for EU leaders to double their funding in the fight against Ebola to £800 million.
It comes after one of the doctors who discovered the virus, Professor Peter Piot, said the rest of Europe was not doing enough to tackle the epidemic.
Downing Street said the current total contribution from the EU was just £400 million.


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Barbara from ClipperGirl's Saving Spot is the Deal Seeking Mom Store Expert for CVS. At ClipperGirl's Saving Spot, she saves her readers time and money by finding rock bottom prices on items that they use every day.
Scroll down to share your CVS Deals and Scenarios!
New to couponing? Read up on what all of these abbreviations mean first in my quick reference guide.
New to CVSing? Want to learn how to create your own CVS deals? Get a quick overview with CVS 101 for Newbies.
More Store Deals:
Let's share our best CVS Deals and Scenarios! Just link up your blog post via the Mr. Linky below.
To keep it neat, I suggest that you list your blog name and then describe your scenario in parentheses, ex. Deal Seeking Mom (Less than $6 OOP!).
The only requirement is that you link directly to your scenarios. Links directly to your homepage will be deleted. Linking back to this meme to share it with others is greatly appreciated!


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Anderson, CA | Customer Service Reviews
Protecting Your Business from Fire is Our Business...
Customer Service Reviews for Anderson, California
CFS Fire Protection, Inc. is a Professional Fire Code Compliance Inspection, Testing and Certification Company providing National Fire Protection Association (NFPA-10) compliant and California State Fire Marshal enforced Fire Protective Equipment and Services throughout Northern California. Because our Customers are located all over Northern California, we have separated our Customer Service Reviews by the Local Cities where our Customers have their Businesses and all the following Reviews are from Customers in the City of Anderson, CA 94501 where Services like our New Customer FREE Compliance Inspection Bid or our Annual Fire Extinguisher Inspection Services were performed. More About CFS Fire Protection, Inc.Our Website (http://CFSFireProtection.com) is Mobile Smartphone Friendly and you can always give us a call at (866) 584-3473 to ask questions and schedule Services to help keep your Business in Fire Code Compliance and We are Really Only a Phone Call Away! We also provide Onsite Live Fire Demonstration Fire Extinguisher Training Courses to give your staff hands on experience operating the Portable Fire Extinguisher Equipment as well as the proper methods to activate Restaurant Kitchen Fire Suppression Systems and Commercial Sprinkler Fire Suppression Systems that can help Protect Your Business!
Google Reviews: CFS Fire Protection, Inc. Clients can provide a Google Review from our Google Listing (See Example)
Fire Protection Services in Anderson, CA 94501
Fire Extinguishers: Annual Inspection, Recharge, Testing, Maintenance & Certification
Restaurant Kitchen Fire Systems: Inspection, Certification, Recharge, Testing & Maintenance
Food Truck Fire Systems: Inspection, Certification, Recharge, Testing & Maintenance
Food Service / Concession Stand Fire Systems: Inspection, Certification, Recharge, Maintain & Test
Sprinkler Fire Suppression Systems: Inspection, Certification, Testing & Maintenance
Fire Hydrants: Inspection, Testing, Maintenance & Certification
If your Business is located in Anderson California and You Need Professional Fire Code Protection, Inspection & Certification Services, Give Us a Call (866) 584-3473. We have all the Fire Protection Services Your Anderson Business Needs to Get and Stay Fire Code Compliant!


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Aaron Swartz, the brilliant young software programmer and Internet activist who inspired awe and reverence from leading figures in the technology world, died in his Brooklyn apartment on Friday, his family said in a statement. New York City's chief medical examiner ruled the death a suicide by hanging. Swartz was 26 years old.
A computer prodigy, Swartz co-authored an early version of the popular Internet tool RSS at age 14 and would later become an early leader of Reddit, the social website that has become a locus of Internet activism.
A passionate advocate for social justice, Swartz founded the group Demand Progress, which played a crucial role in persuading the U.S. Congress to back down from controversial antipiracy legislation last year.
"Aaron's insatiable curiosity, creativity and brilliance; his reflexive empathy and capacity for selfless, boundless love; his refusal to accept injustice as inevitable — these gifts made the world, and our lives, far brighter," his family said in a statement. "Aaron's commitment to social justice was profound and defined his life. He used his prodigious skills as a programmer and technologist not to enrich himself but to make the Internet and the world a fairer, better place."
Swartz believed deeply that information — particularly that which might benefit society — should be made available for free to the public. In 2011, Swartz was indicted on federal data-theft charges for breaking into the MIT computer system and allegedly downloading 4.8 million documents from the subscription-based academic research database JSTOR.
Swartz was facing up to 35 years in prison and a fine of up to $1 million. He pleaded not guilty. His trial was set to begin this April.
(MORE: Reddit Co-Founder Aaron Swartz Indicted for Data Theft, Could Face 35 Years in Prison)
In 2008, Swartz wrote a program to download some 20 million pages of legal documents from PACER, the Public Access to Court Electronic Records system, which charges 10 cents per page for access. Working with other activists, Swartz sought to make the documents available to the public at no charge. The government cracked down on this effort but did not file charges.
Swartz's efforts to "liberate" information from JSTOR and PACER made him a hero — indeed a legend — among Internet activists. Swartz was an early leader at Reddit, the giant online activist hub that has become a potent force in Internet politics. Reddit was sold to publishing giant Condé Nast in 2006. He later founded the group Demand Progress, which would play a key role in the epic 2011–12 battle between Internet activists and the entertainment industry over controversial antipiracy legislation. (TIME Warner, parent company of TIME, supported the legislation, which was ultimately defeated.)
Swartz, who studied at Stanford University for one year before dropping out, would later become a fellow at Harvard University's Edmond J. Safra Center for Ethics, where he worked with Lawrence Lessig, the renowned law professor and activist. Over the years, Swartz worked with Lessig on several major projects, including Creative Commons and Rootstrikers.
"He was brilliant and funny," Lessig wrote in a blog post Saturday. "A kid genius. A soul, a conscience, the source of a question I have asked myself a million times: What would Aaron think?"
(MORE: SOPA Protests Gain Steam as Web Activists Flex Growing Clout)
Swartz wrote candidly and movingly about his struggles with depression and other illnesses. In a 2007 blog post, he described lying in bed for weeks at a time. "Go outside and get some fresh air or cuddle with a loved one and you don't feel any better, only more upset at being unable to feel the joy that everyone else seems to feel," Swartz wrote. "Everything gets colored by the sadness."
In a statement, Swartz's family criticized the way the federal government has handled the JSTOR case. "Aaron's death is not simply a personal tragedy," his family wrote. "It is the product of a criminal-justice system rife with intimidation and prosecutorial overreach. Decisions made by officials in the Massachusetts U.S. Attorney's office and at MIT contributed to his death."
News of Swartz's passing prompted an outpouring of grief from those who knew him well, as well as from the broader technology and Internet community. "Aaron had an unbeatable combination of political insight, technical skill and intelligence about people and issues," Cory Doctorow, co-founder of the technology site BoingBoing, wrote in a heartfelt tribute to Swartz. "I think he could have revolutionized American (and worldwide) politics. His legacy may still yet do so."
Tim Berners-Lee, who is considered the founder of the World Wide Web, wrote on Twitter: "Aaron dead. World wanderers, we have lost a wise elder. Hackers for right, we are one down. Parents all, we have lost a child. Let us weep."
Swartz's family and friends have set up a memorial page here.


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Our adorable traditional brown teddy bear is made with super soft fluffy fur perfect to cuddle up to, full of character, and with a friendly face, this bear is the ideal gift for young or old.
Brand New and in Immaculate Condition:
This delightful brown teddy bear arrives brand new, wearing a heartwarming "I Love Cross Country" t-shirt.
Safety Certified and Quality Assured:
Our teddy bear has undergone thorough testing and has been certified for its high quality and safety standards. It's a reliable and safe choice for ages 3 and up.
Teddy Bear Specifications:
- Height (Seated): 20 cm / 8 inches
- Width: 15 cm / 6 inches
- Depth: 8 cm / 3 inches
- Material: Super soft plush fur
- Packaging: Brand new, wrapped in cellophane
- All new materials used
- Fully approved, tested, and certified for safety ages 3+
Safety Note:
Please be aware that due to small parts, this toy is not suitable for children under 3 years of age.
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Wednesday, April 7, 2010
Governor Kulongoski has a Decision to Make
Governor Ted Kulongoski of Oregon finds himself in the unenviable position of deciding the fate of two professions. And he has to do it either today or tomorrow.
Yes, I hyperbolize...a little. Senate Bill 1046 would not actually hand psychologists prescription pads. Instead, the bill would allow the Oregon Medical Board to issue prescriptive privileges to psychologists who are properly trained. Before any privileges are handed out, however, a task force of psychiatrists and psychologists would have to hammer out final guidelines, including exactly how much training is required, what kind of collaboration with physicians is needed, and which medications psychologists would be allowed to prescribe.
The Governor has put this bill on a list of measures that he is "threatening" to veto. Apparently, this is his invitation to all the stakeholders to whip themselves up into even more of a frenzy in their efforts to lobby him. My wild guess is that Kulongoski was initially in favor of the bill, but as crunch time arrived and he got more and more of an earful from Oregon physicians worried about loss of income, he began to reconsider. These last few days will serve as a quick straw poll to find out how much political damage he might do to himself if he were to sign the bill.
Personally, I support the bill because I believe it requires enough medical training to produce safe prescribers. At least two Oregon psychiatrists support the overall concept of psychologists prescribing, including Jim Phelps, who wrote this editorial in favor of the bill in Psychiatric Times, and Joseph Arpaia, who has commented on this blog. Both Dr. Phelps and Dr. Arpaia are joining with me in forming a multi-disciplinary study group to develop a list of principles for appropriate training of psychologists interested in prescribing. If anybody else wants to join, please e-mail me directly at email@example.com. I suspect there are many more open minded psychiatrists out there who are afraid of "coming out" on this issue because they fear the wrath of colleagues.
Although I have been asked to actively lobby for this bill, I've declined, for various reasons, not the least of which is financial. I get most of my income from psychiatrists subscribing to my newsletters. The more political I become on this issue, the more I fear subscription cancellations.
But more nobly, I think there is a far more important underlying issue than this particular bill. There is a critical shortage of psychiatric prescribers in the U.S. The most recent estimates by the University of North Carolina Scheps Center, published in a series of article in Psychiatric Services, documented a shortage of prescribers in 96% of U.S. counties, and estimated that only 50% of the needs of psychiatric patients are currently being met. We must offer more realistic solutions than telepsychiatry, increasing residency slots (which we can barely fill with qualified applicants as it is), and phone call consultation with primary care doctors.
Rather than lobbying for specific bills, I want to get psychiatrists and psychologists together to jointly come up with a position paper on best practices for training, supervising, and monitoring prescribing psychologists. This could then serve as a blueprint for prescription legislation in other states (and in Oregon, which will surely pass another version of this bill next year if the current one is vetoed.)
39 comments:
"a critical shortage of psychiatric prescribers in the U.S.?" Hmm, I have to take that with a huge grain of salt. Absolutely everyone I know is either taking a psych med or being urged to take one. They aren't having any problem getting someone to prescribe them something either. Since deciding what pill to prescribe is highly subjective or dictated by current marketing practices and since more often than not the meds cause harm rather than benefit at least over the long term and even over the short term in some cases (sorry, but I truly believe this), I can't really support increasing the ranks of prescribers. The education that existing prescribers really need is about the drugs' toxicity to the body and brain and I don't see that being put at the top of the agenda with further educational requirements anytime soon.
- April 7, 2010 at 12:10 PM
- Debra said...
This bill, and this issue risk linking psychiatry AND psychology to prescribing medication in the public's minds.
Like... psychiatry AND psychology=medication.
At a time when we should be PULLING BACK AT LEAST A LITTLE from this equation.
A fair amount of "harm" has already been done on this issue. Why make it worse ? - April 7, 2010 at 12:25 PM
- SteveM said...
I can't speak to the clinical trade offs of the Oregon initiative because I'm not a clinician. But I really applaud your efforts for two process reasons:
1) You are actually doing something rather than merely recycling the same issues and moving food around the plate. (Platitudes and wishful thinking drive me nuts.)
2) You acknowledge at least implicitly that Pareto optimality in real life is an illusion. And The Perfect is the enemy of The Good Enough.
Psychiatry needs more intelligent, take action pragmatists like yourself. Good luck with that... - April 7, 2010 at 12:27 PM
- Daniel Carlat said...
Sara and Debra-
I certainly hear your concerns. If you believe that people are already over-medicated you might believe that giving another profession prescriptive privileges is crazy. But as it turns out, anecdotal information is that the prescribing psychologists in New Mexico and Louisiana have adopted a much more conservative prescribing style--therapy first, pills second. Many of their patients come to them on a long list of meds and their expertise is getting them down to one or two, by using psychotherapies that help with the symptoms.
So paradoxically, expanding prescriptive privileges to psychologists will almost certainly reduce the per-patient number of prescriptions while allowing those who really need an SSRI, eg., to get it. - April 7, 2010 at 12:54 PM
Thanks for the response, Dr. Carlat, and I do agree that having one person in charge of someone's care is important. If this passes I truly hope this works out the way you envision.
- April 7, 2010 at 1:05 PM
- moviedoc said...
You justify allowing psychologists to prescribe based on the idea that this will address all those under-served counties, but I don't hear anything that would require these psychologists to practice in under-served areas. I believe 1) prescribing psychologists will stay in the same over-served areas, and 2) the psychologists who choose to prescribe will be the ones who have failed at what they set out to do in the first place.
- April 7, 2010 at 5:06 PM
Professional Suicide.
That is what you and like minded colleagues are colluding to do.
I just don't get you anymore. What did your mentors teach you in medical school and residency? To just give in to people who crave the skills we painstakingly learned that do separate us from other disciplines that did not make the sacrifices we voluntarily agreed to make when accepting that medical school matriculation?
It is so disappointing to read people who you think really are making the effort to take a stand and reset the boundaries that have been so ridiculously twisted instead just cave. And I don't care if you don't agree, because I know in my heart that giving in when the going is tough just sells out our colleagues who stand by the oath and committment.
You know, my wife read your last post about this issue and genuinely said to me, "what is his problem!?" She knows that I once was a subscriber to your newsletter and really valued your writings and efforts. I think after this latest escapade of well intentions just ending up as fodder for the quick fix crowd is finally getting her to realize what I am so upset about.
This is not what I envisioned. And Obamacare is the final nail of the coffin that buries psychiatry.
The antipsychiatry crowd must be cheering in their little happy place. And then they can turn their attention to psychology.
If you remember, look me up in 2014. I sincerely doubt I will still be practicing psychiatry. The question is, will it be because I had no choice but to leave as the field is lost, or this legislation will just push it out the door?
And to think I pulled out your Psychiatry Interview book this week as a reference for the latest locums I am doing.
Well, good luck in your pursuits. Even if you do not put this comment in the thread, I hope you keep it for prosperity. Maybe you can show it to me in 4 years and tell me how wrong I was.
Or, maybe not. - April 7, 2010 at 7:48 PM
I am a psychologist at a major academic medical center and I agree with moviedoc and Dr. Hassman. I believe that if you want to prescribe meds, then go to medical school. There is nothing to stop a PhD in Clinical Psychology from going to medical school, and then he or she will be a MD/PhD and have the mental health world as his or her oyster! I also believe we have too much prescribing going on for mental health issues-- I mean My God you don't have to be a psychiatrist to prescribe. Studies indicate that most of the psychotropics prescribed are by non-psychiatric MD's anyway. Psychologists should stick to what they (we) are trained to do -- psychological and neuropsychological testing and psychotherapy. A lot of education and training goes into developing those skills. We don't need prescribing curricula in a PhD program!
- April 7, 2010 at 9:46 PM
- Joseph Arpaia, MD said...
Dr. Hassman and the Anonymous commenter after him: Do you not realize that psychologists ALREADY have the right to prescribe in several states and that they are only going to increase that number?
The question facing us is not "Will psychologists gain prescribing rights?" as that question has already been answered in the affirmative.
The question facing us is "Will those who have the most expertise and training on prescribing psychotropics have input into the processes by which psychologists gain prescribing privileges or will they stay aloof and allow others with much less training to make all the decisions?" - April 7, 2010 at 11:02 PM
"The antipsychiatry crowd must be cheering in their little happy place. And then they can turn their attention to psychology."
Dr. Hassman, as someone who has cheered alot of your posts, why are comments like this necessary? All this is doing is being inflammatory instead of contributing to the discussion.
As I said to Dr. Carlat, when I felt he made an unfair similar comment, you all don't like it when your profession is unfairly stereotyped. So why is it ok for you to engage in similar type behavior?
As an FYI, as one who has been critical of psychiatry (but who is not antipsychiatry), I am not cheering this at all. I greatly fear that if psychologists are given drug prescription privileges, their profession will eventually look like psychiatry meaning that there will be very little therapy and mostly med checks. It won't happen overnight but that is what will occur in my opinion.
That means less options for people who are looking for alternative mental treatments to meds. As a result, I greatly fear people won't get the help they need which would be a tragedy.
AA - April 8, 2010 at 5:47 AM
- Debra said...
Since I'm looking at the mother country with a telescope, I can say..
That it looks like people are ALREADY pulling back from the ALL medication "solutions" to what many of us have decided to call "mental illness"...
This is good news.
I can't say that I endorse "pragmatic" solutions to any problem, though.
Because "pragmatic" solutions are JUST NOT UTOPIC enough for ME. The uh, EXTREMES DO have their purpose. And, to be pragmatic about this.. we are NOT going to make them go away just because we want them to.
It takes...ALL kinds to make a world. Let's try remembering this, right ?
And, food for thought :
Are the psychologists who are RESPONSIBLY prescribing, and taking over care doing so... BECAUSE THEY ARE PSYCHOLOGISTS, or because TIMES THEY ARE A CHANGING ?
Hard to tell, in my book. - April 8, 2010 at 9:46 AM
- Daniel Carlat said...
Please limit your use of all caps in comments, because they are the typographical equivalent of SHOUTING and don't serve to further rational discussion.
The Management - April 8, 2010 at 10:21 AM
- Asslete said...
I am not an apologist for psychiatry. I do see the value of meds and my interventions on a daily basis with true Bipolar and Psychotic folks.
But I gotta agree with Sara. I don't think we have a critical shortage of psychiatric prescribers. We have a critical overage of psychiatric med use.
In my past life, I had access to a database of 60 million covered lives. I ran an analysis on antidepressant prescriptions in 2009. There were some segments (perimenopausal women) where antidepressant use approached 50%.
If 50% of a population requires psych meds, then arguably, insanity is the new norm...and perhaps we should be medicating those of us who are blissfully content off meds. - April 8, 2010 at 2:39 PM
- Joseph Arpaia, MD said...
The issue of too much prescribing is not really relevant to the question of psychologist prescribing as there is no evidence that this will increase prescribing.
The forces driving excessive prescribing are several, but from my perspective two are:
a) the reimbursement rate per hour for med checks is absurdly greater than that for doing therapy. This is but an instance of the excessive reimbursement for "procedures" under the current system.
b) direct-to-consumer advertising and disease mongering have convinced millions who are simply struggling a bit with life that they are ill and need treatment. This puts an excessive burden on the health care system and too many providers fill their practices with the "worried well".
c) swamped primary care doctors treat the multitudes with the treatments recommended by the drug-company reps as they do not have the time to really provide effective treatment.
These systemic issues are not going to be touched by the issue of prescribing psychologists and wasting our energy in that conflict will only reduce our effectiveness in changing the system as a whole. - April 8, 2010 at 5:04 PM
- Dr John said...
I have very mixed feelings about this and have no desire for more people prescribing psych meds but have some hope psychologists will not fall into the same hole everyone else has. I can see no reason why they could not be trained to prescribe but does anyone buy into the idea they will not bow to the same market forces that have caused the rest of the medical practitioners to pollute the US with psychotropics as Asslete points out? If so how can this be prevented?
- April 8, 2010 at 6:20 PM
How can this process be prevented?
Our illustrious representatives in Congress should have re-examined what ERISA allowed insurance companies to do to psychiatry specifically, medicine in general, and done what was the right thing to do and take them out, what, about 15 years ago. Maybe striking the insurance industry from that protective legislation would have created more accountability on them, and they wouldn't have chipped away our professional responsibilities, as they did with a sledgehammer.
There was a psychologist/lawyer who wrote awesome columns detailing exactly this in Psychiatric Times in the mid 90's (sorry I don't have his name, I am doing temp work 2 hours away from my home to review files). And of course, no one listened, no one took a stand, no one thought about it and just let the system screw us.
And now I have to watch my back as my own colleagues are embracing the adage "if you can't beat em, join em!"
Dr Arpaia, do you realize that the next profession to pursue this will be social work, and with the logic you and your colleagues embrace and sell so easily will validate it?
Just be honest with those of us who really like practicing psychiatry the way we were trained at accredited and responsible programs, what are you falling back on for income WHEN you can't provide the majority of your yearly earnings as doctors? Because between issues like this, Obamination-care, and the ongoing devaluing of psychotherapy as a legitimate intervention for mental health care, what will be left for a psychiatrist to offer as a provider?
Are you so certain you are right that you do not have to entertain this as a possible scenario? - April 8, 2010 at 6:55 PM
Here is the headline from the Oregonian, folks:
Kulongoski vetoes bills on prescriptions
"Oregon psychologists won't be prescribing drugs anytime soon.
Medical groups and even some psychologists opposed the bill.
Kulongoski said such a change "requires more safeguards, further
study and greater public input." "
Amen to that! For more on all this, we have a number of comments and discussions on the Psychiatric Times website.
But rather than gloat, psychiatrists need to realize that this issue will come up over and over, each year, in one state or another. We need to do much more to educate the public and our representatives on the important differences between psychiatric physicians and psychologists.
We psychiatrists also need to put our own house in order, and work to ensure that psychotropic medication is prescribed for the right reasons, in the right way, at the right time--and only after thorough evaluation and consideration of non- pharmacological options.
We also need to explain to the general public and our psychologist colleagues why separating "prescribing" from the art and science of general medicine is like trying to separate bone from muscle, using a paring knife: you can't do it without injury to the patient.
Ronald Pies MD - April 8, 2010 at 8:30 PM
- moviedoc said...
Dr. Arpaia says, "This is but an instance of the excessive reimbursement for "procedures" under the current system."
If psychotherapy is not a procedure, then something is wrong. Medication management is definitely NOT a procedure.
All this "too much psychotherapy" vs. "too much medication" should embarrass all professions involved. Patients should get the treatment that works for them, and the patient should have a say in it. No patient should have to sit through psychotherapy just because the psychiatrist or psychologist requires it. - April 8, 2010 at 9:07 PM
- Joseph Arpaia, MD said...
By "prodecure" I meant CPT code. Psychotherapy has a couple of CPT codes 90804-9 for instance. The "med check" is a procedure, 90862.
The fact that health professionals are reimbursed based on procedures is, in my opinion, at the root of the dysfunction in our system.
If a doctor spends time talking to patients to help them change their lifestyle the reimbursement is far less then if they ignore the lifestyle issues and then treat the complications of that.
Even if a doctor is willing to take the hit in income by using the lifestyle change approach, their employer won't tolerate that and will schedule them with far too many patients for them to do that. Going into solo practice will avoid that issue, but it is simply not an option for most doctors. Here is a link to an article which describes this problem, http://content.healthaffairs.org/cgi/content/full/29/4/732?etoc - April 9, 2010 at 8:58 AM
- Joseph Arpaia, MD said...
Wow, here today's post from Hooked on the same reimbursement issue:
http://brodyhooked.blogspot.com/2010/04/whats-driving-overuse-of-complex-spinal.html - April 9, 2010 at 9:06 AM
I think the fact that psychologist are even thinking that they can behave like physicians is a direct consequence of terrible standard of care being provided by psychiatrist. We as psychiatrist have really stopped practicing medicine and have become prescribers which makes psychologists think that they can write prescriptions too.
Its time for psychiatry as a profession to wake up and start behaving like physicians instead of becoming prescribing agents.Our jobs go much beyond scripts but how many of us truly know about all the medical illnesses or medications our patient are on.How many of us bother to find out exactly what birth control our female patients are on and so on, how can we see 40 patients in one day?
We have set a bad example of what psychiatry is and we need to fix it or our profession will be obselete soon.
We must take back what is ours. - April 9, 2010 at 9:20 AM
- moviedoc said...
Dr. Arapaia: I'll admit everything we can get reimbursed for (which is not to say everything we should get reimbursed for) has a procedure (CPT) code. My point is that psychotherapy is like a surgical procedure. The psychotherapist DOES the treatment. Medication management on the other hand involves assessment and prescription of a treatment. Your point about relative reimbursement is well taken, but now comes the hard part: How much can we as a society afford to pay for psychotherapy, especially given the myth that everyone can use a little, and given that un-managed (as in in managed care) it can go on indefinitely, often with little to show for it. And those 40 patients Anonymous says some of us "see" per day. If that gets knocked down to 7 patients per day where will we get treatment for the other 33?
- April 9, 2010 at 12:40 PM
As readers of this website may already know, Gov. Kulongoski has vetoed the bill in question, raising some of the same concerns about it that many of us in the profession did. I expect that some new version of the bill will again come up for more debate in Oregon, over the coming year.
This should not be the time for gloating or recriminations, however. It is a time for psychiatrists and psychologists to work together constructively, in order to increase access to good, comprehensive, mental health care. It is also a time for physicians (both general and psychiatric) to "buff up" their medical and psychopharmacological skills and training, so that what we provide is a model for responsible care–not an easy "target" for others to seize upon, in order to expand their practice into the realm of medical care.
As a consultant in psychopharmacology for almost three decades, I know that physicians have a long way to go, in achieving a level of excellence in prescribing psychotropics. We all do! But the best way for psychiatrists, PCPs, and psychologists to advance the health care of our patients is to respect the training and expertise of each specialty–and, most important, to advocate for wider access to mental health care in general.
A more detailed blog on this topic will appear shortly on the Psychiatric Times website.
Ronald Pies MD - April 9, 2010 at 2:02 PM
- moviedoc said...
Dr. Carlat: Dr. Pies has invited us to read more at the Psychiatric Times Web site. It seems obvious that the site, its publisher, and indeed I assume Dr. Pies, exist off the largess of advertisements for big pharma. How do you square this with your own stance? Your dilemma seems to be censorship vs becoming part of the pharma ad machine.
- April 9, 2010 at 2:29 PM
- Sadness Addicted said...
Firstly, one should consider that the average prescribing pschiatrist makes $170,000 per year (I'm not sure if this includes drug company baksheesh) and the average psychologist makes $90,000 year. This is due to insurance company reimbursements. It looks to me that Psychologists want to make more money. Why do we need more people prescribing these medications. These meds are over prescribed already. We need more study of the medications. We need psychologists to protect us from the pharmacological assault of psychiatrists.
Prescribing psychiatrists should be referrals from therapists and should not deliver primary mental health care because they are not objective.
A non-prescribing therapist psychiatrist or psychologist should set the treatment plan and there should be a time frame for the medication to prove its effectiveness on the patient.
Mental health will simply become pharmacological.
If we are going to do this we should just make these drugs over the counter meds. That will satisfy big Pharma. Just like addictive cigarettes, any one over 18 can buy their addictive meds at their local CVS.
http://sadnessaddiction.blogspot.com/ - April 9, 2010 at 5:47 PM
- SteveM said...
Re: Dr. Pies.
I am agnostic about the policy actually. Because I'm not a clinician. But if inchoate were a crime, Dr. Pies would be doing hard time. I need a logic machete to hack through this morass.
Re: I know that physicians have a long way to go, in achieving a level of excellence in prescribing psychotropics. We all do!
"We all" is well, you physicians. How can you apportion blame where there is no responsibility?
Re: "It is also a time for physicians (both general and psychiatric) to "buff up" their medical and psychopharmacological skills and training..."
If you guys aren't already "buffed up", that's scary.
Re: "But the best way for psychiatrists, PCPs, and psychologists to advance the health care of our patients is to respect the training and expertise of each specialty–and, most important, to advocate for wider access to mental health care in general."
The ol' Mom and Apple Pie sleight of hand and everything is copacetic. If training is broken, (see Dr. Pies' comments above), then respecting it without comment leads to, well, more broken training.
I don't get it... - April 9, 2010 at 7:08 PM
I think Sadness has a great point. Big Pharma with their swarthy surrogate "academic" psychiatrists have been making the case that SSRI's and what not are "safe" and "side effect free." Let's be real-- SSRI safety and no side effects was the campaign to market these drugs over the "old" antidepressants like imipramine. If all the marketing is true, maybe all SSRI's should be over the counter!
- April 9, 2010 at 9:52 PM
I think justice would be served if legislation is promulgated to see if psychiatrists should have psychotherapy privileges. I can't see any State approving those privileges given psychiatric residency curriculum!
- April 9, 2010 at 10:05 PM
Although it is my policy not to respond to anonymous critics, I do feel compelled to say something regarding Psychiatric Times and the issue of "Big Pharma", conflicts of interest, etc. It should be evident to anyone with a scintilla of economic savvy that a larger "prescriber" pool means more business for Big Pharma, which means more revenues for journals that rely mainly on pharmaceutical advertising (rather than charge a subscription fee). Psychiatric Times falls into that category.
If such a journal, or its editors, wanted to make lots of money, they would clearly and vigorously champion the idea of "psychologist prescribers." So would many authors intent on selling more of their psychopharmacology texts. (One psychologist wrote to tell me she had used my psychopharmacology Handbook in her "masters level" degree program, in preparation for "prescribing").
In fact, if economic self-interest were the chief factor in play, journals with Big Pharma advertising would probably be advocating "prescribing privileges" for social workers, pastoral counselors, and perhaps
for really empathic sociologists, as well. (It is probably just a matter of time, isn't it...?).
By the way, my own position against "prescribing privileges" (i.e., practicing medicine) for psychologists was formulated at least 20 years ago, when I was working primarily for the State of Massachusetts, in a clinic that served some of the sickest and poorest patients in the state. The psychiatrists who worked there did not see much "largess" coming their way.
My 1991 article on the subject may be found in:
Pies R: The "deep structure" of clinical medicine and prescribing privileges for psychologists. J Clin Psychiatry 52:4-8, 1991.
Ronald Pies MD - April 9, 2010 at 10:39 PM
- moviedoc said...
No need to be so defensive Dr. Pies. If you'll read my comment again, I think you can see that I directed a sincere question at Dr. Carlat, not a criticism at anyone. I'm not quite ready to jump on the "satan pharma" bandwagon myself, and I see nothing wrong with you or your publication taking ad money. Conflict of interest is at the essence of fee for service medicine, probably more so than in your work for PT. Interesting point about the financial incentives involved in the question of whether to support psychologist prescribing. I'm not sure I'm ready to believe your stance proves there is no financial motive at work, but I certainly won't dismiss the idea either.
- April 10, 2010 at 12:57 AM
To readers of this site: I apologize if my last comment appeared to be "defensive." I did feel that the reputation of the paper I edit was being besmirched--evidently, I was mistaken. Perhaps I was a bit "primed" for a defensive response, having read one earlier remark, asking whether "psychiatrists should have psychotherapy privileges"(Please imagine the sound of my hair being pulled out!).
I suppose I'm just not cut out for reading anonymous criticisms of this sort on the internet. Where I trained, people took personal responsibility for their comments, especially criticisms; and were willing to expose their "paper trail" to the scrutiny of others. Similarly, all comments on the Psychiatric Times website must include full names, posted publicly.
I'm now working on a piece for Psychiatric Times tentatively entitled: "The Psychiatrist: Once a Physician, Always a Physician." Perhaps I'll be better able to express my feelings about all this in that venue. We will also be publishing a piece on the very extensive and robust training in psychotherapy, provided at Upstate Medical University, in Syracuse, N.Y.
For now, I think I'll say thanks to Dr. Carlat for the discussion, and sign off.
R. Pies MD - April 10, 2010 at 8:34 PM
- Sadness Addicted said...
The prescriber and the therapist need to be independent. There needs to be a treatment plan with tangible behavioral goals. If medication is added to the treatment plan the medication should be started with a target of stopping the medication.
I would see a psychologist instead of a psychiatrist because he could not prescribe and if I were to chose medication we would make an informed decision to seek out an objective psychiatrist and my therapist would maintain an objective baseline of my progress.
I have seen too many people flounder on medication whose psychiatrists see them once ever 90 days for 30 minutes and modify the medications. Brain chemistry Russian roulette is a better term for this type of treatment. This legislation will promote more of this.
Then we have the GP's who share the simplistic ideological belief in the serotonin deficiency model of the early 1970's with Oprah and the general public. The GP's prescribe these potent unpredictable medications like Cymbalta and Effexor like they are antibiotics. OMG.
We need a smaller smarter more supervised group of prescribers working with much better studies. The drug studies need to continue after FDA approval. - April 10, 2010 at 9:26 PM
This is for sadnessaddicted. First I agree that psychologists should not have prescribing privileges. However, that's about where you and I share common ground.
I'm a psychiatrist. You quote the average salary of a "prescribing psychiatrist." I'm not sure what that label means, but I'm sure it's an aspersion. The average psychiatrist graduates from college, spends four years in medical school and another four years (at minimum) in a residency program earning a pittance. Most come out of medical school with a huge debt load. Yes, the average salary of a practicing psychiatrist is about $170K.
Compare that with the average salary of other physician specialists (eg, radiology, dermatology, opthalmology) whose residenies are no longer nor more difficult than a psychiatric residency program. Their average salary is about $400K. Psychiatrists (and other primary care physicians) are not practicing medicine to make money. They do fine, but in general they make no more than mid-management executives in corporate America, and believe me, their lives are far more stressful and the stakes much higher.
You obviously see the pharmaceutical industry as the evil empire and psychiatrists as its puppets. Your view about the state of the science of psychopharmacology is woefully inaccurate, but I am not posting here to change your view about this, simply to point out some facts.
Why is it that we don't hear any raging against oncologists who prescribe medicines for incurable illnesses (sometimes to prolong a life for a few months at most), whose toxicity and side effects make any psychotropic drug look relatively benign? Where is the raging against rheumatologists who prescribe medications for the pain of incurable diseases like lupus and rheumatoid arthritis, whose side effects can wipe out immune systems and lead to death?
Psychiatrists prescribe medicines because they can, and because there are not yet any reliable markers to determine which patients will respond favorably and which won't. Just like oncologists and rheumatologists they attempt to relieve suffering and prolong life in often severely debilitating and incurable illnesses. Psychotherapy has its place in the treatment armamentarian, but it can sometimes only go so far in. Do you not want patients to get every available treatmeent option which may produce a favorable outcome?
You obviously have very deep resentments against psychiatry and against the pharmaceutical industry. I am thankful that we have an industry that has brought new drugs to market. Lives have been saved, suffering relieved, and quality of life improved. We have a long, long way to go in understanding the science of mental illness and in developing effective treatments, both pharmacologic and non-pharmacologic. In the meantime we try our best to help--that's why we went to medical school and chose this profession.
Psychiatry these days is often an impossible profession. Almost always thankless. Your posts are certainly demonstrative of the lack of understanding and respect for the profession. - April 11, 2010 at 6:36 PM
- Dr John said...
anonymous: I think it is very easy to see why there is not the same universal castigation of other specialties. Pathology is much easier to define in most and not so contentious. Regardless, there are many examples of very reasonable and appropriate critiques in other areas such as cardiovascular medicine(cholesterol drugs and stents) and pain mang.(over prescribing of opiods,Cox 2 inhibitors). These are just limited examples.You are right however that no field is so open to obvious criticism or has such a large cheering section of detractors. People are distrusting of psychiatry for many reasons as you can see from reading the posts on this blog.Personal values play a much larger role on how individuals might conceptualize the meaning of an emotional problem and what should be done about it as compared to a tumor. This is why people speak out so strongly against it or so loudly when they feel they have been harmed by it.The risks people should endure in the face of Tx are not so clear as when one is facing a glioblastoma.I agree psychiatry is an impossible profession. I think because of the conceptual issues involved in the entire paradigm this is not likely to change. You state "Lives have been saved" secondary to new TX. Can you provide me some specific references to support this?
- April 11, 2010 at 9:16 PM
- Sadness Addicted said...
My friend the anonymous psychiatrist, rest assured I am not cast aspersions, only trying to set a system of checks and balances. Too many people are prescribed these drugs too often who should not take them by people who don't understand them. Seriously, if psychiatrists actually spent enough time with their patients to diagnose them they would be making far less than $170,000 per year due to the disparity of insurance disbursements for managing patients with medications versus therapy.
My estimate is that 70 - 80% of the people prescribed Effexor and Cymbalta qualify as medically unsupervised.
The state of psychotropic drugs today is primitive, where cancer surgery was in the 1960's.
The general public and most of the medical profession hold a dogmatic belief that the absence of happiness can be explained by a very simply serotonin deficiency model. According to this belief, the absence of happiness is as simple as problem to solve by adding more serotonin as adding insulin is to remitting diabetic symptoms. Anyone who has read the science and followed depression and anxiety patients knows this is not true. The brain physiology and the absence of happiness take together or separately are much more complex than that.
I empathize about your income. The insurance companies and big pharma have you locked in an ethical dilemma. But like the absence of happiness, there is no pill that will fix that problem and it is up to psychiatrists themselves to solve both problem.
Prescribing potent SSRIs and SNRIs to patients who are seen for 30 minutes every 90 days is awful medicine. It is done too often.
12% of the women in this country are on some form of antidepressant medication. This is a bubble as big and ready to burst as the high risk mortgage backed securities market was in 2008. - April 11, 2010 at 11:24 PM
- moviedoc said...
"Prescribing potent SSRIs and SNRIs to patients who are seen for 30 minutes every 90 days is awful medicine. It is done too often." Very true. Many patients are sufficiently stable that yearly visits are adequate, but what on earth would we talk about for 30 minutes? As little as five minutes often suffices, and the need for visits every 90 days just feeds the malpractice monster. (Some expert witness and some judge will somehow conclude that whatever bad thing happened was surely caused by not enough visits, whether they were indicated or not. Too much psychotherapy can be a problem too: firing the psychotherapist should be the goal of treatment from the outset.
Anonymous psychiatrist: We don't just prescribe meds because we CAN. We do it because they work, they're well tolerated, and because our patients choose that modality.
Correctly done psychotherapy works too, and it probably is undervalued. Let's hope our patients continue to have a choice: either or both. - April 12, 2010 at 8:53 AM
- Unknown said...
As a clinician, I am stunned by the irresponsibility of statements such as:
"Many patients are sufficiently stable that yearly visits are adequate"
10mg fluoxetine a yearly visit might be suitable but 375mg venlafaxine definitely not. Let's be clear.
"but what on earth would we talk about for 30 minutes? As little as five minutes often suffices[?]
Hmmmm I don't know how to respond to this. What could a clinically useful 5 minute dialogue consist of?
"firing the psychotherapist should be the goal of treatment from the outset."
Independence of both the psychotherapist and medication should be the goal.
Sadness may have evoked MovieDoc's antagonism due to her two earlier posts and he really may not feel this way. He may at the same time synically be agreeing Dr. Arpaia's point that the health networks will force the doctor's towards medication dominated therapy.
Thomas Rueben
Stuttgart, Germany - April 12, 2010 at 2:03 PM
firing the psychotherapist should be the goal of treatment from the outset.
Hey moviedoc: Firing the psychiatrist should also be the first goal of treatment! But the problem is, as research has demonstrated, that firing the shrink leads to relapse and intolerable side effects; firing the psychologist results in long standing treatment gains as least as regards to depression! Do the research! - April 13, 2010 at 10:55 PM
- moviedoc said...
Anon: Did you mean to say firing the psychologist results in long standing treatment gains? My point is that endless psychotherapy where the patient incorporates the psychotherapist as a significant other has negative effects. I believe that applies when the psychiatrist does the psychotherapy, too. Stopping the medication is not always a goal. Some patients will benefit from some drugs lifelong. Analogy from the general medical world: insulin for diabetes. Treatment gains from psychotherapy can also occur after termination.
- April 14, 2010 at 9:48 AM


text:
By Steve Stephens
The Columbus Dispatch
Take A Seat offers an occasional look at things to see and do in one of Ohio's 88 county seats. This stop: Marietta in Washington County
MARIETTA, Ohio — Few places in Ohio are as picturesque as this town, at the confluence of the Ohio and Muskingum rivers.
None is as historic.
Marietta is the oldest city in the Buckeye State, founded in 1788 at a time when crossing the Ohio River from the east meant hacking through the wilderness on the other side and entering the frontier.
Visitors nowadays will have an easier time traveling to Marietta, but they can still see the home of Rufus Putnam, a Revolutionary War general and friend of George Washington's who was one of the town founders.
The Buckley House Restaurant offers fine Mediterranean style cuisine in Marietta, OH; May 28, 2017 (Steve Stephens / Columbus Dispatch) Steve Stephen | Columbus Dispatch
MARIETTA, Ohio — Few places in Ohio are as picturesque as this town, at the confluence of the Ohio and Muskingum rivers. None is as historic. Steve Stephen | Columbus Dispatch
Putnam's log house was part of Campus Martius, a stockade built to protect the first settlers. The house has been preserved on its original foundation within the Campus Martius Museum.
The rest of the large, three-story museum tells the story of the old Northwest Territory from prehistoric times through the flood of migration into Ohio.
Just outside the museum building is the Ohio Company Land Office, where the first settlers recorded their claims. The building, constructed in 1788, might be the oldest structure in the state.
Take A Seat offers an occasional look at things to see and do in one of Ohio's 88 county seats. This stop: Marietta in Washington County
If you go Marietta
The Washington County seat is the state's oldest permanent settlement, founded by Revolutionary War veterans in 1788.
Visitors these days will find plenty of history plus a delightful downtown with historic buildings filled with shops, restaurants and places to stay.
More information
To learn more about Marietta, call the Marietta-Washington County Convention and Visitors Bureau at 1-800-288-2577 or visit www.mariettaohio.org.
Another fine museum, the Ohio River Museum, is located on the Muskingum River but is close enough to the Ohio that visitors could hear a steam whistle there. The museum concentrates on the golden age of the steamboat and includes the restored W.P. Snyder Jr., the last stern-wheeled towboat in the United States.
Visitors who want to ride a sternwheeler can stop next door. The Valley Gem offers narrated sightseeing cruises and a series of special excursions throughout the summer and into the fall. I love hearing the slap of the stern-wheel paddles against the waters of the Ohio and Muskingum as the boat cruises past verdant islands and under huge bridges.
In downtown Marietta, visitors will find many interesting shops, inviting restaurants and a couple of historic hotels, including the venerable and comfortable Lafayette, located on the Ohio River near the mouth of the Muskingum.
The Lafayette's well-appointed Gun Room restaurant and Riverview Lounge are both reminders of elegant riverboat days. Guests can even stay in rooms made to resemble riverboat passenger cabins.
Craft beer lovers should stop at the Marietta Brewing Co., which offers tasty brew in an attractive old building decorated with colorful murals.
For fine Mediterranean fare, try the Buckley House Restaurant in a historic house across the street from Muskingum Park. Other good restaurant options downtown include Jeremiah's Coffee House on Front Street; the Galley restaurant in the Hackett, a historic boutique hotel; and Austyn's, across from the Lafayette hotel.
Hidden Marietta Tour Co., located in the Lafayette, offers walking tours of the city, including a spooky Ghost Trek tour.
In fact, Marietta offers plenty of delightful places to walk off a good meal, including a scenic 3.3-mile walking and bike path along both rivers. But I'd suggest a stroll through Mound Cemetery and the surrounding neighborhood.
The cemetery takes its name from the ancient Indian mound at its center, a reminder of the people who lived in Marietta before Putnam and his fellow settlers. Around the mound are hundreds of graves, some dating to the earliest days of settlement — including more than three dozen Revolutionary War veterans, Putnam included.
The neighborhood surrounding the cemetery contains some magnificent old homes, including the Castle, one of the best examples of Gothic Revival architecture in the state. The house, built in 1855, is now a museum owned by the city. Among the many interesting features is a notable fireplace of scagliola, a beautiful imitation marble made of painted plaster.
From the Castle, visitors will certainly note the triple towers of the Spanish Renaissance-style Basilica of St. Mary of the Assumption, built in 1904. The magnificently decorated and lovingly restored Catholic church is definitely worth a stop. Visitors will find self-guided tour brochures just inside the front doors.
For another great stroll, cross the downtown pedestrian bridge over the Muskingum River to Historic Harmar Village, a cute neighborhood with several restaurants and shops and a few small museums.
On the high bluff above Harmar is another cozy lodging, the House on Harmar Hill bed and breakfast, with a view from the front porch that's one of the most dramatic in the state.
That same view can be admired from Lookout Point on Bellevue Street just off Route 7. From there, the panorama soars out across the city and both rivers, encompassing the breathtaking confluence where civilization and wilderness once met.


text:
Trust But Verify
The Obama administration wants to partner with the e-commerce industry to make sure citizens are who they say they are online. But it's not clicking yet.
The Obama administration wants to partner with the e-commerce industry to make sure citizens are who they say they are online. But it's not clicking yet.
Imagine visiting any government website for the first time and immediately accessing services without having to register. Think of it as an online express lane akin to the airport security gates that allow prescreened travelers to whiz through without taking off their shoes and belts. And imagine the money that agencies providing these accounts could save by eliminating duplicative ID verification systems. Federal officials are pushing to turn this fantasy into online reality.
The Obama administration has handed the private sector a blueprint for building a network similar to the credit card payment system for secure online transactions. But this network would exchange online identities, the currency of the 21st century. The National Strategy for Trusted Identities in Cyberspace has the support of businesses and even wary public interest groups. But protecting online transactions worldwide is expected to take years of negotiations among Internet companies, governments and individuals "Portions of an identity ecosystem exist today, but it's not quite unified in a way that NSTIC envisions it," says Jeremy Grant, who heads the effort as a senior executive adviser at the National Institute of Standards and Technology.
The framework for "federated identity management" should solve several Internet problems by allowing any site to rely on third parties for issuing and verifying a person's digital credentials. Currently, Internet users must create a new account for every service they want to access online, requiring that they deposit personal information all over the place. Sites must shoulder the costs of setting up and maintaining their own independent ID validation systems, and visitors must remember multiple passwords to interact with each agency or business.
Another hitch is that sites often ask for more personal information than is necessary simply to send users alerts or to save Web page settings. Fraudsters, who can easily crib passwords or hack into customer databases, then can steal that information to commit identity theft. As a famous canine cartoon in The New Yorker summed it up nearly two decades ago: "On the Internet, nobody knows you're a dog." Because there's still no way to substantiate who you are online, sensitive transactions like the issuance of Social Security cards are restricted to costly agency field offices.
By outsourcing credentialing operations to trusted third parties, agencies and companies are likely to cut costs and boost customer service, federal officials say. The combination of stronger ID confirmation and privacy restrictions also can "put individuals more in control of their data," Grant adds.
But there is no credentialing industry yet. Firms interested in creating a marketplace have hit a number of obstacles that Grant says government can help overcome. For one, there aren't sufficient compatibility standards- an area where NIST can help. And policy issues like liability and privacy are unclear-another area where government can assist.
A Little Push
Many say government is suited to become an early adopter, with its gigantic user base and critical need to provide citizens, such as Federal Student Aid applicants, with secure online services. ID theft-including breaches of Internal Revenue Service and Veterans Affairs Department databases-costs the average victim 130 hours and $631 to recover, according to the Commerce Department. Citizens will start asking, " 'Why can't I have the same credential to log into VA and the IRS and FSA?' " Grant says. "If agencies can stop building what's essentially the same credentialing system, you should be able to save money."
With the exception of the National Institutes of Health, government has been slow to embrace nongovernment sign-on services. As with transitioning to the cloud-renting space from a third-party's data center online-agencies contend that allowing outside credentials requires giving up control. Instead departments concoct their own duplicative ID systems.
Agencies perhaps just need a little push-or shove.
The White House in mid-October said agencies must accept certified commercial credentials when launching or upgrading their websites. Administration officials say they won't rule out the option of choking off funding for agencies that don't comply, and those that neglect to transition during site overhauls must submit a plan for future adoption.
ID providers certified to verify usernames and passwords for the government include Google, Equifax, PayPal, Symantec and Wave Systems. Under the new policy, an agency would embed, say, a PayPal button on its home page that would allow users to log in to access secure information. A successful sign-on would then instantly open the agency's site. NIH, so far, is the only federal agency that allows visitors to log in this way.
For agencies that want a higher level of verification, such as smart card authentication or in-person enrollment, the policy calls for outside credentials only "where appropriate and as resources permit." Currently, no ID management vendors are certified to provide those credentials, according to federal officials.
In releasing the memo, federal cybersecurity czar Howard Schmidt wrote on the White House blog that other agencies besides NIH need to start trusting outside ID validators.
"A citizen who is a veteran, a college student and a taxpayer ought not to have to obtain separate digital credentials at each agency website, but instead should be able to use ones he or she already has-a university-issued credential for example-across sites hosted by the departments of Veterans Affairs, Education and Treasury," he wrote. "Doing so allows the federal government to streamline the customer experience and recognize real cost savings just when we need to be tightening our belts. Moreover, by using accredited identity providers, federal agencies see to it that Americans' information is treated with privacy and security online."
Risk and Rewards
NIH estimates it will save about $3 million between 2011 and 2015 without the burden of managing IDs across 50 systems. Visitors now register with existing credentials to cull information from multiple research databases. Federal officials say the government could slash ID management costs by up to 80 percent if all agencies subscribed to a shared credentialing service. Each agency would pay for the authentication service based on licensing costs, its user base and numbers of servers hosting the agency's site.
NIST has prescribed four categories of ID trustworthiness. Level 1 requires a visitor to enter a username and password on Google, for example, to access low-risk information such as personalized news feeds. Google verifies that the person's password and username exist, but there is no proof of identity required. A mother and son, for instance, can share the same account. Level 4 requires a visitor to scan a smart card containing personal information and biometric fingerprints to, say, wire $1 million. The individual must prove his or her identity in person to obtain credentials.
The cost of software and services for accepting basic identity credentials runs from zero to well under $1 million, says J. Brent Williams, chief technology officer of Anakam, Equifax's identity proofing product line. Prices for obtaining higher levels of assurance range from $5 million to $10 million because the effort involves enrolling users' unique traits, verifying those traits for each transaction and storing that identity information securely. Equifax is applying to become a certified Level 2 and Level 3 provider for the government, he says.
Some identity management experts, however, say that adoption in the federal government will be a challenge. There's a desire to accept third-party IDs, says Mike Ozburn, a Booz Allen Hamilton principal who consults on federal identity safeguards, but tight budgets stymie new initiatives. That said, a great innovation like the iPhone can gain traction across the marketplace rather quickly, he adds. An ID provider could develop an easy-to-use service that e-commerce sites and consumers find irresistible, which in turn could put pressure on agencies to adapt. "The fact that they don't have a budget* for NIST right now doesn't mean the industry isn't moving forward," Ozburn says. "The same people that government would call citizens, businesses call customers."
The health care industry and banks, for instance, are eager to access sensitive patient records and financial statements on the go, through mobile ID services, government and business executives say. Jim Williams, a 30-year veteran of the federal government who served as acting administrator of the General Services Administration under President George W. Bush, says the private sector has to pursue an ID eco-system collaboratively, but much faster.
Central to security is the ability to cancel credentials networkwide if IDs are compromised, says Williams, now an executive at Daon, a firm that provides identification verification software. "You've got to be able to revoke quickly. If somebody does hack into it, à la Sony, and steals your identity and passwords, what you're worried about is somebody being able to steal your biometrics," adds Williams, who also served as director of U.S. Visitor and Immigrant Status Indicator Technology, the Homeland Security Department's biometric identification program.
Supporters of the concept have raised concerns that disseminating personal information through fewer channels could increase the extent of damages if one ID is exposed. A hacker who steals a trusted credential could essentially have a master key to the victim's bank accounts, health records and other critical information. Grant says relying on one ID provider is no more risky than using the same password for all accounts, which is common among Internet users nowadays. Web surfers have the option of using multiple credentials, multiple ID providers-or no IDs at all, he adds.
Think of having one digital credential for paying taxes and banking and a separate one, maybe "pinkpony55," for posting anonymous comments in online forums, including ones hosted by government agencies, says Aaron Brauer-Rieke, a fellow at the Center for Democracy and Technology. "What we hope we don't see is requirements for a credential with my legal name," he cautions.
Forcing Americans to register for credentials under their real names veers into the territory of a national ID or online driver's license, which civil liberties groups like CDT detest.
Signing Everyone Up
Brauer-Rieke expects the plan will not become a national ID because the credentials aren't mandatory and the White House envisions the private sector leading the effort. The term "identity ecosystem" implies multiple identity providers, rather than a state-owned system, he adds. And the strategy takes into account privacy by asking all participants to abide by "fair information practice principles," or universal codes of conduct for protecting personal information on websites.
But it remains to be seen whether the entire information superhighway will take to the idea, Brauer-Rieke notes. The tools to accomplish the goal already exist but not the cooperation, he explains. "I can't use my Facebook login to go to Bank of America," he says. "I can't use my Twitter login to go to Amazon. The problem is not in the technology that is available. The problem is getting consensus and standards out there to make it work." Grant says Facebook Connect has been "one of the biggest federated identity success stories to date," adding he would love to see Facebook apply for certification like some of its competitors. Facebook declined to comment for this story.
Other civil liberties activists, while not yet concerned about the current approach, dispute the notion that industry is in charge. "If the folks doing NSTIC succeed in their goal of creating an identity ecosystem, it's not the national ID that I oppose," says Jim Harper, director of information policy at the Cato Institute. But he does object to the Commerce Department running the effort. "Industry-led initiatives are not run by the government," he says. One worry is the government could decide to cut waste by requiring everyone to file taxes online using a credential tied to their driver's license, he says.
Even if the administration carries out the plan as is, the next president could change the rules, Harper notes. "If the government is the lead actor in this ecosystem, well, the government's going to end up calling the shots," he says. "And when we have a bad day, if heaven forbid there's some kind of terrorist attack, watch the government turn on a dime and drop the idea of an open ID system."
In Grant's view, however, the ID plan is basically no different than other government strategies that assist industry. "The U.S. government has an agricultural strategy, but that does not mean we are growing crops and raising cattle," he says. "The only thing the Commerce Department is running is a process to convene stakeholders and to facilitate collaboration among them."
Grant notes that the U.S. Chamber of Commerce and the Commerce Department jointly announced the strategy at the Chamber's headquarters in April. "There's a reason that bastions of free-market capitalism like the U.S. Chamber of Commerce have endorsed NSTIC," he says. "It's because they understand that the government needs to play some role here in removing barriers to private firms in the space, so that the marketplace can thrive."
*Editor's note: This article went to press before Congress passed the National Institute of Standards and Technology's budget for fiscal 2012.
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