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For much of this millennium, the United States has relied on familiar linear, unilateral problem-solving approaches a Micro Domestic paradigm This atavistic bias makes US policy increasingly ill suited for today President Bush s foreign policy, for example, could be a page stolen from Ronald Reagan s early 1980s playbook His war on terror is akin to the war against communism, with the axis of evil supplanting the evil empire The great reliance on increased military spending is reminiscent of Reagan, with our economy increasingly exhibiting the twin de cits that developed under that administration Beyond defense, US postures and policies on energy and fossil fuel use, agriculture, and the environment also seem woefully out of step with twenty- rst century realities While the Micro Domestic approach may have worked well enough in a bipolar world, it demands serious reappraisal today We live

Routine determination of serum PRL in men consecutively seen for hypoactive sexual desire without ED (n = 53), anorgasmia/retarded ejaculation (n = 74), and premature ejaculation (n = 124) [210,249] found no HPRL in the two former sexual dysfunctions However Schwartz et al [250] reported on some male HPRLs revealed by isolated hypoactive sexual desire or anorgasmia In contrast, serum PRL was mildly elevated (20 35 ng/mL) in 13 men with premature ejaculation (10%) This was not the cause of sexual dysfunction since bromocriptine failed in every case to prolong the time to ejaculation In addition serum T was normal in every case and no pituitary adenoma was detected in any patient

18 10 hypothyroidisms and three hypoadrenalisms of central origin among 41 ED patients with macroprolactinomas

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most cases due to their anti-dopaminergic activity)

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in what physicists might call a quantum world, one of in nite connections As we ve outlined, there are now many, not only one or two, power brokers Additionally, the scale of global interaction that occurs today is dizzying compared to 100 years ago or even 20 years ago The amount of information, goods, money, and people that now cross borders, and the velocity of these movements, has permanently altered the international landscape To prosper in this new environment, we need a new approach what I call a Macro Quantum paradigm that can better cope with more players, greater interconnectivity, and less predictability Just as a modern medical doctor wouldn t operate on a heart without monitoring the brain and lungs; similarly, we must not operate in world without thinking of the rami cations to Beijing, London, and Brasilia, as well as to the earth itself In simple terms, we must see the entire elephant not just individual parts Whereas a Micro Domestic paradigm relies on past strategies, the Macro Quantum perspective is forward thinking, understanding that new ways are needed for further progress A Macro Quantum perspective assumes cross-border relations are unpredictable not xed Importantly, the Macro Quantum paradigm acknowledges that there are many ways forward, and the right choice depends on situational context as opposed to one correct approach While some Americans may pine for the sense of moral clarity of an us-versus-them world, we must readjust our thinking to realize there are no right or wrong solutions anymore, just better or worse And lately the latter have won out For example, American-style democracy may work for us, but that doesn t mean imposing a constitution and a bicameral parliament on every nation will create functional government, let alone a prosperous country The highly differentiated states of the Macro Quantum world, each with unique traditions and histories, demand custom-made solutions not one-size- ts-all Whereas under the Micro Domestic approach, the United States aimed to control countries and events, in the Macro Quantum world we endeavor to build partnerships to in uence and help manage trends During the Cold War, the United States never had to question the allegiance of its NATO allies In addition to the looming threat of the Soviet Union, the United States used its massive economy and military.

Opiates Methadone Psychotropic drugs Neuroleptics Benzamides (+++): Amisulpride, Sulpiride, Sultopride, Tiapride Phenothiazines: Chlorpromazine, Cyamemazin, Fluphenazine, Levomepromazine, Perphenazine, Pipotiazine, Propericiazin, Thioridazine Butyrophenones: Droperidol, Haloperidol, Pipamperone, Flupentixol, Loxapine, Olanzapine, Pimozide, Risperidone, Zuclopenthixol Tricyclic antidepressants Amitriptyline, Amoxapine, Chlorimipramine, Desipramine, Dosulepine, Doxepin, Imipramine, Maprotiline, Trimipramine Anti-emetics Metoclopramide (++), Metopimazine Anti-ulcerous Cimetidine (only at high dose) Anti-hypertensives Reserpinics, -methy-DOPA Estrogens

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