Three days after HHS released its 80-page report summarizing 500-plus responses on what’s required to build a nationwide network of interoperable health data exchange, HHS Secretary Mike Leavett announced on June 6 a multipoint plan for the private sector to join the reds in transforming “health care as we know it.”

Leavett announced the formation of the American Health Information Community (AHIC), a public-private collaboration of up to 17 members that will advise HHS on “how to make health records digital and interoperable, and assure that the privacy and security of those records are protected.” At the same time, Leavett firmly pushed the reds into a leadership post, saying that more than one-third of all U.S. healthcare is paid by the federal government, and that it should demonstrate leadership in the areas of architecture, standards and certification for future interoperability.
AHIC was designed for an initial two-year life span, with an option to extend up to five years. After that, AHIC will be sunsetted and HHS expects that a private-sector healthcare IT initiative will take over the AHIC role, adopt “additional needed standards, certify new health information technology and provide long-term governance for health care transformation.” Leavett summarized the government’s leadership role by saying that “once the market has structure,” efficiencies, healthcare innovations and improvement in care delivery would be the purview of patients, providers, medical professionals and vendors.
Beyond formation of AHIC, Leavett also promised that HHS soon will issue four RFPs around creating processes for setting standards, IT certification, architecture for an Internet-based nationwide exchange of health information and privacy/securities policies. He anticipates a federal spending of $200 million in two years, including HHS’s dedication of $86.5 million in fiscal 2005 and the $125 million requested by President Bush for fiscal 2006.

Drawing rare and rapid support from both sides of the Congressional aisle and wide agreement from healthcare organizations, a bill introduced in mid-May looked by early June to be headed for quick passage in the 109th Congress. The 21st Century Health Care Information Act, introduced by Rep. Tim Murphy (R-Penn.), and cosponsored by Rep. Patrick Kennedy (D-R.I.), promotes creating more regional healthcare information networks that showcase interoperability of medical record software. Also, Sen. Hillary Clinton (D-N.Y.) said she was working with former speaker Newt Gingrich (R-Ga.) on a companion to the House bill that would “spur the adoption of electronic record-keeping applications.”
When introducing his bill, Murphy underscored the need for action by reporting several findings: Lab and radiology results and medical histories were missing during 13.6 percent of patient visits in a recent JAMA study; improper medications are prescribed in about one of every 12 physician visits, per a CDC report; and patients receive recommended care only about 55 percent of the time, according to a Rand Corporation investigation. Murphy also pointed out the need for a more coordinated national effort, citing that 32 states and the District of Columbia have funded healthcare IT initiatives and that 23 federal agencies have adopted standards for electronic exchange without coordination with private industry or individual states.
Murphy’s House legislation (H.R. 2234) would give the Department of Health and Human Services (HHS) Secretary the authority to award up to $50 million total in 20 grants in fiscal 2006 to help establish interoperable regional health information networks and promote the adoption of IT products. It also authorizes similar spending on regional health information organizations (RHIOs) grants in each fiscal year from 2007 through 2010. The law would require RHIOs that receive federal grants to utilize federally-certified healthcare IT products. The overseeing federal agencies will have approval rights if an IT certification process is not yet in place by the time the projects are implemented, in 2006 or 2007.

RHIOs have been taking root across the U.S. since late 2004, when federal seed money helped establish five programs (in Colorado, Indiana, Rhode Island, Tennessee and Utah) to demonstrate exchange of health data among systems with varying software products. Many RHIOs, including new ones in California and Massachusetts, have sprung up without help of federal funds.

In May, Massachusetts formally launched three large-scale regional health IT pilots in Brockton, Newburyport and northern Berkshire. Led by not-for-profit Massachusetts eHealth Collaborative, it is also funded in part by $50 million from Blue Cross Blue Shield of Massachusetts. Also in May, CalRHIO, a statewide network managed by the non-profit Health Technology Center, announced it would electronically link state emergency departments and ultimately permit transfer of patient data between labs, pharmacies, hospitals and physician offices.

Murphy’s bill earned favor from many physician organizations including the American Academy of Family Physicians, the American College of Physicians and the American Health Care Association. The bill directs AHRQ (Agency for Healthcare Research and Quality) to create a National Technical Assistance Center to assist physicians, financially and technically, and to give priority to small practice.

Clinical Quiz questions are based on selected articles in this issue. Answers appear in this issue.

American Family Physician has been approved by the American Academy of Family Physicians as having educational content acceptable for Prescribed credit hours. Term of approval covers issues published within one year from the beginning distribution date of January 2002. This issue has been reviewed and is acceptable for up to 4 Prescribed credit hours. One half hour of these credit hours conforms to AAFP criteria for evidence-based CME clinical content. Credit may be claimed for one year from the date of this issue. When reporting CME credit hours, AAFP members should report total Prescribed credit hours earned for this activity. It is not necessary for members to label credit hours as evidence-based or Prescribed for CME reporting purposes.
The American Academy of Family Physicians is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The AAFP designates this educational activity for a maximum of 4 hours in Category 1 credit toward the American Medical Association Physician’s Recognition Award. Each physician should claim only those hours of credit that he or she actually spent in the educational activity.

AAFP Credit

Each copy of AFP contains a Clinical Quiz answer card. AAFP members may use this card to obtain the designated number of Prescribed credit hours for the year in which the card is postmarked.
AMA/PRA Category 1 Credit

AAFP members who satisfy the Academy’s continuing medical education requirements are automatically eligible for the AMA/PRA.

Physicians who are not members of the AAFP are eligible to receive the designated number of credit hours in Category 1 of the AMA/PRA on completion and return of the Clinical Quiz answer card. AFP keeps a record of AMA/PRA Category 1 credit hours for nonmember physicians. This record will be provided on request; however, nonmembers are responsible for reporting their own Category 1 CME credits when applying for the AMA/PRA or other certificates or credentials.

For health care professionals who are not physicians and are AFP subscribers, a record of CME credit is kept by AAFP and will be provided to you on written request. You are responsible for reporting CME hours to your professional organization.

NOTE: The full text of AFP is available online (www.aafp.org/afp), including each issue’s Clinical Quiz. The table of contents for each online issue will link you to the Clinical Quiz. Just follow the online directions to take the quiz and, if you’re an AAFP member, you can submit your answers for CME credit.

INSTRUCTIONS

(1) Read each article, answer all questions on the quiz pages, and transfer your answers to the Clinical Quiz answer card (bound into your copy of AFP).
(2) A Mail the Clinical Quiz answer card within one year (by September 30, 2003). The bar code on the answer card contains your identification for CME credit hours.

THE STATE OF REPROCESSING

Reprocessing offers health care providers a patient-safe, economic alternative with a proven safety record. (1) Medical devices represent the highest recurring expense to hospitals after staffing. Reusing rather than disposing of these expensive devices translates into cost savings that can be reinvested in resources (eg, more nurses, new technology) health care providers may need to better serve patients.

Reprocessing is not a secret. Hospitals have reprocessed devices safely for two decades, and third-party reprocessing has become a $40 million-a-year industry. (2) Even before the FDA’s updated guidance was issued, third-party reprocessing was regulated by the FDA. Regulations governing reprocessing have existed for as long as there have been regulations for medical devices. The Federal Food, Drug, and Cosmetic Act, established in 1938 and amended in 1976 to include medical devices, regulates the sale of devices intended for use on humans in the United States. Reprocessed SUDs are not excluded from these regulations. In fact, the FDA/ORA Compliance Policy Guides Manuals, issued in 1987, assigns responsibility for the safety and effectiveness of a reprocessed SUD to the party performing the reprocessing. (3)

Third-party reprocessors must comply with a host of regulatory requirements, the most significant of which is the Quality System Regulation (QSR), which includes extensive controls over all manufacturing operations (eg, cleaning, disinfecting, packaging, labeling, sterilizing, distributing). The FDA’s QSR requirements apply to both third-party reprocessors and OEMs, as do the premarket submission requirements in the FDA’s guidance. Reprocessors take exhaustive measures to ensure the quality and effectiveness of reprocessed SUDs for physicians, hospitals, and patients.

When the FDA was formulating its guidance for reprocessing SUDs, one major issue was whether hospitals that reprocess their own SUDs would be considered manufacturers. If they were, the FDA would have regulatory oversight of their reprocessing activities. A secondary issue was whether third-party reprocessors and hospitals would have to submit premarket notifications for reprocessed SUDs, either through the 510(k) premarket notification process or the premarket approval (PMA) process. This point was debated because reprocessors essentially would be submitting a device for premarket clearance that already had received premarket clearance when first introduced by the OEM. Ultimately, the FDA decided that hospitals and third-party reprocessors would be regulated in the same way as manufacturers. There was never a question as to the regulatory status of third-party reprocessors, however, because the FDA always has regulated them.

THE LABELING QUESTION

A three-tiered classification system for devices listed in the Code of Federal Regulations (CFR) forms the basis for determining what type of premarket clearance is required of any new medical device. This system applies to all devices, not just reprocessed SUDs. For a time, the FDA looked at a special classification scheme for reprocessed SUDs, but it ultimately decided to use the existing system. In August 2000, the FDA issued a guidance document titled “Enforcement priorities for single-use devices reprocessed by third parties and hospitals.”

Competencies have been used as a performance management tool to achieve competitive advantage in a number of industries, and can be defined as the knowledge, skills, and behaviors that differentiate superior performance. To develop a competency model for medical writers, you need to define the key roles for your organization (eg, coordinating author, project manager) and assign the appropriate competencies to them. This is commonly achieved using a card-sort exercise. Competencies can be considered behavioral (eg, communication) and technical (eg, knowledge of the International Conference on Harmonization guideline) and it is usually a combination that defines superior performance. For training and developing a medical writer, you need to look at the competencies associated with each roles) carried out by the individual, and identify the most critical development areas, taking into account any performance feedback. Appropriate training can then be arranged such as ‘on-the-job’ training, coaching and mentoring, attendance at courses, and self-study.

HE USE OF COMPETENCIES as a performance management tool is not a new concept, and it has been applied to achieve competitive advantage in a number of industries.

WHAT ARE COMPETENCIES?

Though the precise definition may vary from company to company, competencies can be defined as the knowledge (what we know), skills (our application of the knowledge), and behaviors (what characterizes our approach) that differentiate superior performance. It is important to distinguish these from competence, which is the minimum qualification to do the job.

The purpose of using competencies to manage people, or competency-based management, is to try and raise the performance level. To carry out a job, an individual needs minimum or basic skills (eg, these days most jobs require the ability to use a computer). Focusing on these alone will not give performance enhancement as it will not separate out individuals who are superior performers. The challenge is defining the competencies required for particular roles and thereby recruiting and training people appropriately.

HOW ARE COMPETENCIES USED?

Competencies provide a consistent platform and common language for managing people across the business and provide clarity for both the manager and the individual being managed. They should fit in with any people management systems you already have in place. Competencies can potentially be applied in selection, individual development and training, performance management, compensation, succession planning, and promotion. You need to decide what competencies will be used for and to whom they will be applied.

Thus, we can use competency-based management to respond to the following questions:

What type of people should I recruit?

What should be the focus of my employees’ training and development efforts? and

What should I consider for performance planning, performance review pay, promotion, and succession planning decisions?

WHEN IS COMPETENCY-BASED MANAGEMENT A POTENTIAL SOLUTION?

It may be that the performance management systems already in place in your company are sufficient and that competency-based management would not add anything significant. Therefore, a business case should be made before embarking on the development of competency models. One example of a situation where competency-based management is a potential solution is when the competencies that your organization needs change, for example, your organization is redesigned and given new objectives and/or your client requires changes in how you deliver your product (new technologies, new approaches and behaviors). Another example may be that competitive advantage is achieved through attracting, developing, and retaining top talent, and your current approach to selection is not achieving this and/ or your people management processes are not effectively developing or reinforcing the correct competencies.

In the medical writing world the environment changes on an ongoing basis, for example, new regulatory requirements emerge such as the need to provide electronic submissions and the introduction of the International Conference on Harmonization Common Technical Document. Medical writers need to adapt to these changes.

HOW DO YOU DEVELOP A COMPETENCY MODEL?

In order to develop a competency model you need to define the key roles for your department/division/organization and assign the appropriate competencies to them (Figure 1). It is important to involve appropriate levels of management and individuals to whom these roles apply in order to ensure that you build understanding, commitment, and quality models.

Role Discovery and Definition

You first need to define the key roles required to achieve the organization’s business strategy. For a medical writing department, examples of key roles may be a coordinating author and a project manager. You then need to define the accountabilities and responsibilities associated with these roles. In order to do this you can use a number of tools, including review and analysis of job descriptions you already have, interviews with relevant staff, and client interviews. In developing role descriptions you need to take into account environmental factors such as the competition, regulatory requirements, and customer demands. To illustrate the definition of a key role, we can use the example of a coordinating author. The purpose of the role is defined below with examples of an accountability and a responsibility:

The term “forensic” is from the Latin, meaning forum or a place where legal matters are discussed. Forensic medicine and dentistry (odontology) deal with the professional handling, examination, interpretation and presentation of medical and dental evidence that come before legal authorities. Although the MiriamWebster dictionary dates the term from 1659, a full text on the subject dates back to 6′h century China. Forensic identification techniques go back even further. In 45 AD, the Roman Emperor Nero used dental impressions to identify slaves; this practice continued throughout Europe and the United States during the slave trade. In 1867, Oscar Amoedo, an Italian dentist, helped identify hundreds of victims of the Great Fire of Paris. Techniques and protocols developed during that fire are still in use today.

The term “forensic” is from the Latin, meaning forum or a place where legal matters are discussed. Forensic medicine and dentistry (odontology) deal with the professional handling, examination, interpretation and presentation of medical and dental evidence that come before legal authorities. Although the MiriamWebster dictionary dates the term from 1659, a full text on the subject dates back to 6′h century China. Forensic identification techniques go back even further. In 45 AD, the Roman Emperor Nero used dental impressions to identify slaves; this practice continued throughout Europe and the United States during the slave trade. In 1867, Oscar Amoedo, an Italian dentist, helped identify hundreds of victims of the Great Fire of Paris. Techniques and protocols developed during that fire are still in use today.

PRACTICAL APPLICATION

orensic study was originally directed toward identification of the living as well as the dead. To that aim, it is important to note that teeth are extremely durable, able to survive millennia with little or no degradation. Variations in morphology can assist in determining geographic origins. Wear patterns are often indicate a persons oral habits, occupation, and even dietary characteristics. The Presidential assassin John Wilkes Booth was identified with dental records. Dr. Joseph Warren, an American Revolutionary patriot, was identified at Bull Run by means of a sterling silver partial denture fabricated by Paul Revere. Serial killer Ted Bundy, in the absence of any “smoking gun,” was convicted primarily on bitemark evidence left on his victims. Amidst controversy, dental records ultimately identified the remains of Adolph Hitler and Eva Braun.

Anthropometry, the branch of anthropology that uses comparative bony measurements to assist in determining racial origins, was the prevailing discipline used in the study of the skeleton in the late 19th and early 20* centuries. With the advent of xray technology, however, the field of forensic study broadened substantially. Forensic scientists began to use bony anomalies, fractures and prostheses to confirm identification, as well as to contribute information on sex, nationality, and even social standing and occupation.

Soon after Austrian physician Karl Landsteiner introduced blood typing in 1901, he and others employed this new discipline in the field of forensic study. Also in 1901, Sir Richard Henry, newly appointed head of Scotland Yard, forced the adoption of fingerprint identification to replace anthropometry as the prevailing identification technique. Advances in forensic study proceeded continuously, prompting a group of physicians, dentists and scientists in 1950 to form the American Academy of Forensic Science (AAFS). This organization subsequently began publishing what has become one of the premier journals on the subject, the Journalof’Forensic Science.

Progress in the fields of forensic medicine and dentistry expanded in 1984, when Sir Alec Jeffreys developed the first DNA profiling test. In 1986 he used his test in the successful prosecution of Colin Pitchfork, who was suspected and ultimately convicted of murdering two girls. Interestingly, in the course of the investigation this same test was first used to exonerate an innocent suspect. In 1987, DNA profiling was used successfully in the United States during the trial of a sexual predator in Orlando, Florida. Later that year, similar evidence was challenged in the case of New York vs. Castro. The result of this scrutiny “culminated in a call for certification, accreditation, standardization, and quality control guidelines for both DNA laboratories and the general forensic community.” Today, DNA is becoming the “gold standard” in the area of forensic identification and criminalistics.

THE POSTMORTEM IDENTIFICATION PROCESS: THE STATION NIGHT CLUB FIRE

On February 20, 2003, in The Station fire disaster, 100 people lost their lives, making it the fourth most deadly club fire in the nation’s history and the worst fire in the history of the state. Forensic odontology was a major part of the postmortem identification process.

The forensic process began at the scene, as it usually does. Survivors were extricated and transferred to local and regional hospitals. While victims normally would be extensively photographed on site, this was not practical or appropriate because many bodies, victims as well as injured, were stacked in doorways and near exits. The first priority, therefore, was to locate survivors, some trapped below the dead. Victims were then assigned a numerical identification and transported to the state morgue. Since the physical plant at the Office of the State Medical Examiner (OSME) was not adequate to handle the volume of victims, refrigeration trailers were brought to the state facility.

Byline: REPORTED BY SANDRA YIN AND LOUISE WITT

If 2004 were to have a personality, it would be a drama queen. We may not know exactly what the year has in store for us, but if nothing else, we know that it won’t be boring. The war in Iraq slogs on. The presidential campaign kicks off in earnest. The Summer Olympics return to Greece. The Internet grows up with legit music downloads. Biotech drugs let Americans recapture their youthful vigor. Men and woman experiment with sexual taboos, although a growing segment of our society longs for a return to traditional values. College students, unlike their Gen-X predecessors, are now more conservative.

America is more entangled with the rest of the world than at any other time in history. We buy clothes from China, cars from Japan, fruits from South America and luxury goods from Europe. When we call for tech support, the person at the other end of the line may not be in Indiana, but in India. Yet, more Americans are homebodies. We’re more likely to remodel our kitchens than book a trip to see the pyramids in Egypt. We’re more likely to eat take-out than splurge on a three-course meal. And if we do go out, we want to eat casual, inexpensive food. Blame the lackluster economy or 9/11 - or both.

As we deal with scary new diseases, such as SARS, we’re using information from the human genome to create drugs to tackle illnesses that have plagued us for generations. Biotech firm, Genentech Inc., for example, plans to market Raptiva to treat psoriasis. For years, people afflicted with the itchy skin condition used stinky coal tar derivatives to alleviate their symptoms. Other drugs that are based on knowledge of our DNA will also be available this year.

President George W. Bush passed substantial tax cuts, letting Americans pay less to Uncle Sam. Still, many feel financially strapped. States and local governments increased taxes and fees to close their budget gaps; the employment rate is still below its highs of the late ’90s, and many workers who have jobs find that they make less than they did before. To make money go further, Americans shun upscale stores in favor of discount centers, such as dollar stores, and mass merchandisers. But many people will still splurge on flat-screen TVs.

The twelve months ahead promise great accomplishments, historic events, as well as shattered expectations. If anything, 2004 will be memorable for the even greater changes it will set in motion. - LOUISE WITT

Marian Burros

Food writer, The New York Times

We’re still in the comfort food phase. Restaurants are offering down-home type of foods. Barbecue is really big in New York. Pearson’s Texas Barbecue is jammed. Retro restaurants, like Brennan’s a new old-fashioned steakhouse in New York, are also popular. Ordering small plates of food, like tapas, is growing in popularity. This started in San Francisco and now it’s on both coasts. Zaytinya is the hottest restaurant in Washington, D.C. You can have some bites, have a drink and order more plates. It’s casual and inexpensive. Those are two things people are interested in these days. People are also eating at home more than they used to, because fewer women are working. Maybe they’re ordering in, or buying carry out, but they’re eating at home.

Grant Clauser

Editor-in-chief, Dealerscope, a consumer electronics magazine Philadelphia

MP3 sales will be strong with more iPod wannabes. In 2004, there will be 10 or so. Napster’s relaunch, as a legitimate pay file service, will increase their penetration. We’ll see more flat-panel TVs. Prices are coming down and more non-Japanese manufacturers offer them. Hard drive-based video recording, like TiVo and Replay, will increase. TiVo is in the public language like Xerox. You hear, “I’ll TiVo that show.” DVD recorder sales will strengthen. Entry-level prices will be under $300. In a year or two, they will be standard on most DVD players. There’ll be more Wi-Fi networks connecting computers to home entertainment centers and to stereos.

Irma Zandl

President, The Zandl Group, a trends analysis firm, New York

With the growth of the Hispanic population (especially Mexican American) and with hip-hop now over 20 years old, a fresh street/urban culture is emerging: cholo culture. Its gang/East L.A. roots give it a gritty authenticity and unique style. Look for it to influence design especially with the Old English lettering, Pendleton shirts and khakis, bandanas, low-rider bikes and cars. Also, look for more entertainment, especially music, to cross over from that culture.

Madelyn Hochstein

President and cofounder, DYG, Inc., a market research firm Danbury, Conn.

Consumers are trying to change their lives by finding more meaning and living a valuable life. They will try to create change, fix things that are wrong, build a legacy and make every moment count. But there’s a roadblock. They can’t get where they want to go, because of security and economic risks. A lot of next year is going to be about sorting out whom we can trust. On the consumer front, we see them trying to take control in the marketplace. They’re demanding more quality, becoming more information-oriented and exploring things about brands that they may not have looked as closely at before. At the same time that we are building our fortress to protect ourselves, we need a furlough. Americans need escapes. Look for “what the hell” behavior and spending no matter what the economic outlook.

The striking diversity of beliefs about paranormal phenomena is a noteworthy and poorly understood characteristic of humanity. On the extremes, some people are almost violently opposed to the very concept of paranormal phenomena and others are equally adamant that such phenomena are real. Neither side has prevailed and there is no indication that either is getting the upper hand (Mathews, 2004; Musella, 2005). Even those who claim tempered scientific perspectives sometimes appear to be living in different worlds. For example, Schumaker (1990), a skeptic, described belief in paranormal phenomena as one of the strongest human motivations and as resulting from the “terror” of facing reality without irrational illusions. On the other hand, Tart (1984), a proponent of psi, described the fear of psi as a powerful, pervasive, instinctive human motivation that prevents the acceptance and occurrence of psi.

As might be expected, the proposed explanations for paranormal beliefs tend to reflect the attitudes of the person proposing the explanation. In his extensive review, Irwin (1993) noted that “much of the skeptical research on the topic seems to have the implicit objective of demonstrating that believers in the paranormal are grossly deficient in intelligence, personality, education, and social standing” (p. 6). These skeptical efforts have also carefully ignored the obvious fact that the deep hostility of some extreme skeptics indicates an irrational prejudice that needs explanation.

At the same time, proponents have done little to offer alternative models or to explain the prevalence of misbeliefs about psi. Many people apparently misinterpret normal experiences as paranormal. Broughton (1991, p. 10) noted that surveys typically find that over half of the population report having had a psi experience, but closer examination of the cases suggests that only about 10% to 15% of the population have had experiences that appear to be possible psi. This estimate is consistent with early surveys (Rhine, 1934/1973, p. 17) and with later studies (Haight, 1979; Schmiedler, 1964). At least 70% to 80% of the people reporting psychic experiences appear to be misinterpreting the experiences.

The motivations for such extensive misinterpretations need to be explored. In fact, understanding the motivations related to attitude toward psi would seem to be a prerequisite for understanding whether, when, and how psi occurs.

The purpose of this article is to summarize and discuss some of the key personality factors and motivations that appear to be relevant for understanding why people believe, misbelieve, and disbelieve in the paranormal. Of course, innumerable personal, social, and cultural factors may have a role in attitude toward the paranormal. The present discussion is intended as a starting point focusing on selected prominent factors. These factors are diverse, and the possibility of conflicting motivations should be recognized.

BACKGROUND

Terminology and Concepts

Certain distinctions in the terminology and concepts related to paranormal phenomena are useful for this discussion. According to the definitions in the American Heritage Dictionary (3rd Edition), “paranormal” is a broad term that means beyond scientific explanation. The term “psychic” is more narrow and refers to extraordinary mental powers such as ESP. This definition of psychic implies that a person is the causal factor for the phenomena, although it can include communication with the spirit of a deceased person. The term “supernatural” means outside the natural world or attributed to divine power. Supernatural typically implies paranormal phenomena caused by a nonphysical being or power that has motivations and intentions separate from those of living persons. Such beings are often considered as God or gods if the motivations are beneficial for people, or as the devil or demons if the motivations are detrimental or evil. The term “miracle” means an event with a supernatural origin. According to the glossary in the Journal of Parapsychology, the term “psi” refers to ESP and PK, which also implies that the phenomena are produced by the mind of a person. Also in that glossary, the term “parapsychology” primarily refers to the study of ESP and PK. Supernatural interpretations tend to be excluded from parapsychological writings and are often assumed to be misinterpretations of psi phenomena produced by living persons. The extent to which psychic and supernatural are different interpretations for the same basic phenomena is an interesting empirical question that remains to be investigated.

The most widely used measures for paranormal beliefs are sheep-goat scales based on psychic phenomena (Palmer, 1971; Thalbourne & Delin, 1993) and the much broader paranormal beliefs scales that also include things like the Loch Ness monster, that black cats bring bad luck, and heaven and hell (Tobacyk & Milford, 1983). The sheep-goat scales were developed by parapsychologists and the broader paranormal belief scales were generally developed by researchers who were more skeptical. The number, validity, and orthogonality of factors in paranormal beliefs have been persistent, unresolved topics of debate (Hartman, 1999; Lange, Irwin, & Houran, 2000; Lawrence, Roe, & Williams, 1997; Tobacyk & Thomas, 1997).

E-mail security vendor Espion International last month released a dual-key system for encrypting e-mail that works with the company’s product gateway appliance or as a stand-alone.

Called MXLock Secure Email, the product is designed to secure outbound emails that relate to government regulations, corporate policy, intellectual property or other sensitive information.

“One thing we feel is very important is ensuring that, with the transmission of information and ideas, they are received by the intended recipient,” says Murali Chakravarthi, CTO of Espion. That can be controlled and locked down.”

MXLock uses two-key encryption; one of the 1,024-bit keys resides at the sender’s gateway, the other is delivered to the recipient as part of the e-mail. When the recipient gets an e-mail from an MXLock user who has encrypted a message, the recipient is directed to click on a link embedded in the e-mail. Once at this Web page, the recipient’s key is authenticated against the key stored in MXLock, and a browser window is opened for viewing or downloading the decrypted message, Chakravarthi explains.

In addition to letting companies send secure e-mail, MXLock can be used as a replacement for FTP transfers, Chakravarthi says.

Administrators can set policies to automatically encrypt outbound e-mails that contain sensitive information by comparing the content of messages to the included dictionary of terms related to the Health Insurance Portability and Accountability Act (HlPAA), or based on other keywords in the body of the e-mail or elements, such as the text of the subject line or the sender, Chakravarthi says.

A number of other e-mail security companies, including CipherTrust, Mirapoint and Sigaba, offer encryption on outbound e-mail through their own technology or via licensing deals with third parties.

For companies covered by HIPAA regulations, being able to have e-mail automatically encrypted is a significant benefit.

“We’re a healthcare facility, so we need to be able to send personal health information and not be sending it in clear text,” says Kate Fuller, network administrator with Trover Clinic and Regional Medical Center in Madisonville, Kentucky. Before installing MXLock, Trover’s users were told they couldn’t send personal health information through email; now with Espion’s product any e-mail destined for certain recipients - a physician, for example - is automatically encrypted.

Fuller could have chosen from a number of e-mail encryption products, but because the company uses Espion’s Interceptor appliance, she decided to wait for MXLock. “Espion’s been real responsive,” she says. “That’s why we were willing to wait for them to develop an encryption product.”

Espion also is working on integrating the artificial-intelligence algorithm used in its Interceptor e-mail security appliance with MXLock. This algorithm “learns” what e-mail users deem valid mail vs. spam and blocks unwanted messages accordingly, Chakravarthi says. In addition, the appliance is “hyper-seeded” with years of understanding regarding what is and is not spam and other unwanted e-mail, so it begins blocking messages as soon as it is installed at an organization, he says.

Espion offers an example of why this artificial-intelligence approach to blocking unwanted e-mail is effective: The Baton Rouge, La., company had many of its customers knocked offline during Hurricane Katrina. Unlike other anti-spam products that rely on constant updates from vendors’ network operation centers to remain effective, Interceptor stores at the customer’s gateway all of the information needed to block unwanted mail, based on this learning approach. Therefore, Espion’s customers did not need to be online during the hurricane and its aftermath to keep blocking spam, Chakravarthi says.

Using this technology MXLock could detect which outbound messages should be encrypted, he says.That version of MXLock is slated for release within a few weeks, according to Ron Kaufman, COO of Espion.

MXLock costs $8,250 for small and midsize businesses, $13,250 for corporations. Interceptor with MXLock is priced at $14,500 for small and midsize businesses, $22,500 for corporations.

Espion offers special pricing for customers affected by Katrina; for those companies in the Federal Emergency Management Agency federal disaster ZIP codes, Interceptor with MX Lock is priced at $9,875 for small and medium businesses and $15,795 for corporations.

Being white, female, an academic high achiever, and singleminded can have its drawbacks, but when it comes to selection for United Kingdom medical schools, no one’s better placed. At least that’s the message from the analysis by McManus of the anonymised data on selection released this week (p 1111).[1] The key findings show, surprisingly, that women are more likely to gain entry to medical schools, but candidates from ethnic minorities remain disadvantaged. Concerns about the selection procedure have long inspired calls for a code of practice.[2]

Differences exist between ethnic minority groups. Caribbeans are less disadvantaged than Africans. Indians are less disadvantaged than Bangladeshis or Pakistanis. While wide confidence intervals hint that some of these differences may not be real, it is undeniable–and suspicions are confirmed–that overall ethnic minorities are disadvantaged. Sceptics will argue that this analysis by McManus doesn’t take into account data on predicted A level grades (which were not made available to him but which selectors rely on heavily), but previous work suggests that even when academic achievement is taken into account ethnic minority candidates are less likely to be accepted, probably on the basis of their surname.[3] This adds to mounting evidence of disadvantage at all stages in the careers of ethnic minority doctors.[4-6]

McManus also finds more Subtle disadvantages. Applicants not wholly committed to medicine on their application forms, those choosing a gap year, and those from colleges of further and higher education and sixth form colleges may be less likely to gain admission to some medical schools. Older applicants and those from lower socioeconomic groups are also disadvantaged. One myth that is not substantiated, however, is that applicants from independent (private) schools are advantaged in terms of selection.

McManus points out that the new evidence raises the possibility of legal action against medical schools under section 17 of the 1976 Race Relations Act. But whether it proves racial discrimination is open to debate. Disadvantage does not necessarily equal discrimination. Legally, direct and indirect discrimination are separate concepts, with direct discrimination hinging solely on an individual’s race, while indirect discrimination arises from some hurdle in the selection procedure that is more difficult for ethnic minority candidates to clear. These data appear to raise issues of indirect discrimination, which may be difficult to prove in court (p 1117).

In the United Kingdom ethnic minorities as a whole are overrepresented in the medical profession. This is explained by the high proportion of applicants of Asian origin to medical schools as well as being a legacy of the days when overseas doctors were more welcome in the National Health Service. Even though they are disadvantaged in terms of selection, enough Asian students apply to ensure that they make up a larger proportion of the medical work force than they do of the population of the United Kingdom. Around 6% of the United Kingdom population are Asian, but they constitute 28% of medical school applicants and 21.7% of those receiving offers of a medical school place. AfroCaribbeans, meanwhile, constitute 2% of the UK population and 3.79% of medical school applicants but receive only 1.72% of offers. By contrast, 64.9% of applicants are white but they receive 74% of offers (IC McManus, personal communication).

Disadvantage, however, can be turned to advantage, as in the case of women applicants–although positive effects on career progression are yet to be seen. By contrast, medical schools in general appear unable to redress the inequalities faced by ethnic minority candidates, despite repeated focus on this issue in recent years.[7 8]

McManus confirms that some medical schools manage not to disadvantage women and ethnic minorities[3] Perhaps the answer is to learn from their admissions procedures. Alternatively, more aggressive policies may be needed; there is, for example, evidence that raising awareness of ethnic minority issues can increase recruitment.[9] Moreover, experience from the University of Arkansas has shown that lowering entry requirements for African-American applicants need not reduce standards: those same students have gone on to score above average marks in medical exams.[10]

The Council of Heads of Medical Schools is to be commended for making these data available; other selection bodies such as the police and the legal profession are much less open about their procedures, and what the deans have done should serve as a model to other professions. The council has also worked with the Commission for Racial Equality to produce an eight point list of “guiding principles” for selecting of students which will be adopted by all UK medical schools. The schools promise to review the criteria for medical student selection, both academic and non-academic; ensure that all medical schools publish and monitor equal opportunities action plans; and monitor and publish the annual figures on applications. Other proposals include further research looking into why certain applicants are disadvantaged, bringing forward the deadline for medical school applications, and reducing the number of choices available on the university application form. The Commission for Racial Equality has threatened to conduct formal investigations into medical schools that fall short.