Alan A. Stone, MD

The U.S. Supreme Court's decision on Atkins v. Virginia has transformed the capital punishment landscape for the mentally retarded. This decision also marks an important step in evaluating the competency of death row inmates of any mental capacity. What could be the future outcomes of this landmark decision?

The World Health Organization (WHO) has distributed for comments the draft of a Manual on Mental Health Legislation as a guide for all the countries of the world. It is to serve as a model for new legislation and as a guide for countries amending their legislation. Given the different legal systems, the cultural diversity and the vast inequalities in economic resources among the nations of the world, one can certainly question the wisdom of the WHO's top-down approach. In addition, everyone who knows the scarcity of competent mental health care professionals and the limited resources in third world countries will recognize that most of the proposals are quite unrealistic. How can nations who cannot feed their poor or meet the basic necessities of public health measures and primary care be expected to provide "incompetent" mental patients with counsel (lawyers) and independent tribunals (courts) before they begin to treat them?

Myron Liptzin, M.D., is a respected psychiatrist who specialized in the treatment of university students. Liptzin retired last year as chief of psychiatry of student health at the University of North Carolina at Chapel Hill, where he had earned a reputation as a skillful clinician who was particularly adept at crisis intervention. If Liptzin had hoped to go on to a less hectic and stressful life, his expectations were shattered when he found himself accused of negligence in one of the most unusual cases of psychiatric malpractice of this century. A former patient went on a rampage-killing two people-and then blamed Liptzin. The verdict against the psychiatrist was front-page news, and CBS's "60 Minutes" went to North Carolina to do a story that aired mid-November 1998. Like a bolt out of the blue, Liptzin had gotten his 15 minutes of unwanted fame.

It is now obvious to most knowledgeable observers that managed care will transform the American health care system. Managed care brought competitive market forces into medicine, and demonstrated that the right financial initiatives can reverse a century of rising professional standards and make health care just another lean and mean downsizing industry.

After the U.S. Department of Veterans Affairs shut down research programs in its Greater Los Angeles Healthcare System (GLAHS) in March, the VA's undersecretary of health, Kenneth W. Kizer, realized that, rather than defending the facility's "failure to correct deficiencies," he would need to launch a reform initiative.