Noteworthy News Articles on Mental Health Topics, August 1-10, 2000

Therapist Faces 2nd Felony Count
Stacie Oulton, Denver Post- 8/1/2000

GOLDEN - The Evergreen therapist who led a fatal "rebirthing" session was charged Monday with a second felony.  Connell Watkins already was facing a felony charge of reckless child abuse resulting in death stemming from an April session that led to the death of 10-year-old Candace Newmaker. On Monday, Watkins was charged with criminal impersonation, the second felony, and two misdemeanors: obtaining a signature by deception and unlawful practice of psychotherapy.  The fourth-grader died after Watkins and three other adults allegedly wrapped her up in a blanket and placed her under a pile of pillows to simulate her mother's womb. The group then pushed on the pillows to cause a "rebirthing" that was suppose to help the girl reattach to her adoptive mother, Jeane Newmaker. But the girl apparently suffocated after vomiting.
    The new charges allege Watkins' claimed to practice therapy under the license of a Neil Feinberg, which was not true. She then deceived Jeane Newmaker into signing a disclosure form by claiming she practiced under that license, according to prosecutors. She also was practicing psychotherapy without being included in the state's database of unlicensed therapists, court documents show.
    Newmaker, who was watching the rebirthing session, also has been charged with criminally negligent child abuse that resulted in death. Also charged with reckless child abuse in the case are fellow therapist Julie Ponder, 39, of Buffalo Creek, Watkins' business manager Brita St. Clair, 41, of Lakewood and intern Jack McDaniel, 47, of Loveland. Judge Charles Hoppin on Monday denied a prosecution request to weigh and measure McDaniel. Watkins and St. Clair already agreed to the procedures.

Alarm on Spreading Ecstasy
Karen DeYoung, Washington Post- 8/1/2000

Two years ago, the amount of the illegal drug Ecstasy entering the United States was worrisome, but not a major concern for federal law enforcement. With most attention focused on cocaine and heroin coming in from South America, searching well-dressed travelers on flights from Paris and Amsterdam for aspirin-sized Ecstasy tablets was not a high priority. Today, Ecstasy is the fastest-growing abused drug in the United States. Although only about 8 percent of high school seniors reported having tried it in 1999, it is the only illegal drug for which significant usage increases were detected last year. In the past seven months, nearly 8 million pills have been seized by the U.S. Customs Service and the Drug Enforcement Administration, 20 times the number seized in all of 1998.
    Amid nationwide alarm, two congressional hearings have been held this summer on Ecstasy, and bills have been introduced in both houses to increase penalties for trafficking and possession. Yesterday, the DEA began a 3-day conference on Ecstasy in Crystal City attended by more than 300 U.S. and international law enforcement officials and drug abuse prevention experts.
    First developed in Germany in 1912, Ecstasy is different from other drugs in the ways it is produced, trafficked and used, challenging traditional notions of how to deal with smuggling and abuse. It has pushed law enforcement into new and unfamiliar areas. "It's changed our institutional mind-set," said Customs Commissioner Raymond Kelly. "We were kind of southern-focused, and now we've had to extend that focus to Europe." In addition to moving personnel and changing techniques--including new scrutiny of passengers on major European airlines--Customs has been forced to put its sniffer dogs on an Ecstasy crash course.
    Unlike cocaine and heroin, the mood-enhancing Ecstasy doesn't originate in remote jungles or highlands. Its components can't be grown in back yards or easily manufactured in basements. At least 80 percent of all the Ecstasy in the world comes from clandestine urban laboratories in just one country, the Netherlands. Most of the chemicals used to make it are controlled under international law, but travel easily to Amsterdam and The Hague from eastern Europe across the newly borderless European Union.
    Most of the Ecstasy entering the United States is trafficked by what DEA calls "Israeli Organized Crime," a nationality not previously associated with the drug underworld. Its chieftains are well-traveled, in their twenties, speak multiple languages and carry more than one passport. Much of their business is conducted via cell phones and computers that allow them to track shipments and distribution on a minute-by-minute basis. Those who have been caught bringing Ecstasy into this country from Europe are an unlikely array of couriers who range from New York Hasidic Jews to Los Angeles strippers to middle-class Texas families. For smuggling purposes, Ecstasy is easy to hide and has an astronomical profit margin. A single pill purchased for 50 cents in Amsterdam can sell for as much as $50 at "rave" dance parties throughout the country.
    Still rarely sold on the street, Ecstasy is most freely available in the cavernous warehouses and clubs where thousands of young people gather for all-night dancing to electronically produced "techno" music. "It's not a very visible drug," said Inspector Cathy Lanier, who heads the Metropolitan Police's major narcotics branch in Washington. "It's concentrated down in the nightclubs, behind closed doors." While they insist they will arrest the possessor of just one pill, local police concentrate their efforts on interdicting large quantities of Ecstasy reaching the area. Tens of thousands of pills have been seized at Dulles International Airport this year on flights from Europe; a bust on a train from New York at Union Station last summer netted 10,000 tablets.
    Known scientifically as 3-4 methylenedioxymethamphetamine, or MDMA, Ecstasy is a ubiquitous subject on the Internet. On sites where erratically scheduled raves are advertised, visitors chat ceaselessly about its availability and purity, and frequently bemoan the fact that ever-younger "kids" are using it. Scientific articles are posted warning of its dangers or attempting to disprove them. The White House Drug Control Policy Office, producer of slick television and billboard campaigns to warn youths and their parents about drug use, does almost all its anti-Ecstasy proselytizing on its www.freevibe.com site and a site devoted to parent education. Called the "hug drug," Ecstasy triggers a chemical reaction in the brain that lowers inhibitions and engenders feelings of well-being and closeness to others. There are few reports of LSD-like bad trips, and virtually no violence associated with its use. So far, it is not considered addictive.
    Ecstasy wasn't even illegal until 1985, and one of the biggest continuing problems for law enforcement is that many of those who use it believe it is harmless. Until recently, there was little scientific evidence to prove the doubters wrong. Immediate side effects include increased heart rate and blood pressure, dehydration, overheating, teeth-grinding and jaw-clenching. Emergency room admissions associated with its use have more than doubled in the past two years, but only a relative handful of deaths have been attributed to Ecstasy. But with major new funding for government and private research into its effects, there is now "pretty good evidence that it probably causes permanent damage to a portion" of the brain, said David M. McDowell, an assistant professor of clinical psychiatry and head of the Substance Treatment and Research Service at Columbia University. The chemicals in Ecstasy impair the function and long-term production of serotonin, a brain chemical that keeps people on an even emotional and cognitive keel and whose absence can lead to major psychological problems, McDowell said. Other recent studies have indicated possible long-term memory loss and cognitive impairment.
    In recent months, there have been signs that more traditional smuggling networks and routes are moving into the lucrative Ecstasy trade. Last February, police in Arizona arrested "Sammy the Bull" Gravano, a former New York organized crime hit man turned federally protected witness, and charged him with involvement in an Ecstasy smuggling ring. But Israelis have been involved in virtually all the major busts so far, according to Customs and DEA. Among recent arrests:
* Last Wednesday, federal authorities announced their largest-ever seizure of Ecstasy, approximately 2.1 million tablets produced in the Netherlands, on a flight from Paris at Los Angeles International Airport. Although several arrests were made, the man identified by Customs as the head of the "drug importation ring," Israeli Tamer Adel Ibrahim, remained at large.
* Also on Wednesday, two Israeli nationals, a French-Canadian and a Native American were arrested and charged with bringing 100,000 pills into New York state from Canada, traveling across the St. Lawrence River.
* Last spring, New York yeshiva student Shimon Levita was sentenced to 30 months in a federal boot camp for participating in an Ecstasy-smuggling ring allegedly run by Israeli Sean Erez, now awaiting extradition from the Netherlands. According to court testimony, Erez paid Levita $2,000 for each new courier he signed up. Prosecutors said the smugglers believed the Hasidic youths--each given $1,500 for carrying 30,000 to 45,000 pills into the United States--would be considered less suspicious by airport Customs inspectors.
* Last month, a year-long Customs investigation code-named "Operation Paris Express" resulted in the arrest of 25 people in connection with a Los Angeles-based smuggling operation. Authorities seized 650,000 Ecstasy tablets with a retail value of $19.5 million. Among those arrested was alleged ringleader Jacob Orgad, identified by federal officials as an Israeli national with smuggling cells in Texas, New York, Florida, California and Paris. Some of Orgad's alleged couriers were strippers, as well as couples who were instructed to bring children with them on the trips. Customs has traced some of the Ecstasy in that case to Washington, where it was allegedly sold to attendees at raves here who were then robbed of both their money and their newly purchased drugs.
    The Clinton administration and law enforcement officials have praised the efforts of Dutch authorities who have attempted to shut down Ecstasy labs there. But Kelly said the Netherlands has become "overwhelmed" by the extent of the problem. At the same time, the administration has made "several senior level interventions" to Israel on the matter, Assistant Secretary of State Rand Beers told Congress last week. "Senior-level Israeli officials have told us they are prepared to move forward," Beerssaid. "But this is a difficult issue within Israel." Israel's laws do not permit extradition of its citizens, and last month the Money-Laundering Task Force of the world's leading industrial nations designated Israel one of 15 "non-cooperating nations" for its lax banking laws.

Clues to Ecstasy's Effects on Addicts
New York Times, 8/1/2000

An autopsy of the brain of a chronic abuser of the drug ecstasy suggests that it may work by causing violent fluctuations in the brain chemical serotonin, according to a report last week in Neurology.  Animal studies of ecstasy, an amphetamine derivative, have found it can trigger a sudden release of serotonin, which has a powerful effect on mood.  Dr. S. J. Kish of the Center for Addiction and Mental Health in Toronto said users of the drug reported increased awareness of emotion and heightened feelings of intimacy.
    The researchers led by Dr. Kish compared serotonin levels of the brains of 11 people who had not used drugs with those in the brain of a man who had died at age 26 after using ecstasy heavily since the age of 17.  "The levels of serotonin and other chemicals associated with serotonin were 50 to 80 percent lower in the brain of the ecstasy user," Dr. Kish said.  "This is the first study to show that this drug can deplete the level of serotonin in humans."  Ecstasy users commonly appear lethargic and depressed after the drug wears off, including the addict in the study, whose friends said he appeared depressed and had slow speech and reaction time after binges.  Further research, Dr. Kish said, may show whether supplementing serotonin levels might help those seeking to go through withdrawal.

The Drinking Debate: Can Alcohol Abusers Drink in Moderation?
Ephrat Livni, ABC News- 8/2/2000

NEW YORK--Last month, in Washington state, Audrey Kishline, the founder of Moderation Management, a self-help group for problem drinkers, pleaded guilty to killing two people while driving drunk. Soon after, Alex DeLuca, the director of the Smithers Addiction Treatment and Research Center in Manhattan, resigned after failing to convince his clinic that moderation was a viable treatment approach for some people who abuse alcohol.
The two events have ignited intense debate among addiction experts over how to treat problem drinking in the United States, where 14 million people, or 7.5 percent of the population, abuse alcohol to varying degrees. On any given day, according to a 1993 National Institute on Alcohol Abuse and Alcoholism survey, more than 700,000 Americans receive treatment for alcohol abuse or dependence.
    Proponents of abstinence point to Kishline’s accident as tragic proof that problem drinkers cannot learn how to consume moderate amounts of alcohol. "What is so terrific about alcohol that we need to keep [them] drinking?" asks Jeffrey Hon, director of public affairs for the National Council on Alcohol and Drugs. He argues that problem drinkers, at any stage, adversely affect the lives of others. Meanwhile, those who accept moderation as a treatment option say absolute solutions drive away drinkers from seeking help.

When is Drinking a Problem?
   For people who are alcohol dependent — commonly called alcoholics — addiction experts agree abstinence is the only treatment. But according to the American Psychiatric Association, there are different degrees of addiction to alcohol. And defining abusers vs. full-fledged alcoholics is a thorny question, and key to the debate. An abuser, according to the APA, is someone who continues to drink although it is the source of social, physical or work problems and leads to an inability to fulfill school or home obligations. A dependence diagnosis is more severe and requires that a person meet criteria such as increased tolerance to alcohol, withdrawal syndrome, persistent desire to drink or failed efforts to control drinking and reduced activities in favor of drinking.
    The Department of Health and Human Services defines moderate drinkers, or those who do not have a problem with alcohol, as those who consume no more than two drinks a day, for men 65 years old and younger, and one drink a day, for men over 65 and women of all ages. Individuals who abuse or become dependent on alcohol often don’t realize how serious their problem is. "Identifying the fine line between the two diagnoses can be difficult in clinical settings and is impossible for most drinking alcoholics," says National Institute on Alcohol Abuse and Alcoholism spokeswoman Ann Bradley.
    Denial is widely considered to be an element of alcoholism, blurring a fine line even further. "But people do not go on and off the wagon and spend time trying to change their drinking if they are not alcoholic," says Rob Morgan, president and CEO of Cybersober.com, who has abstained for more than five years. "One of the biggest problems with alcoholism is denial and moderation allows that to stay alive."

Two Sides, Many Views
   Moderation Management board member Marc Kern says drinking problems, like other behavior disorders, lie on a continuum and people who identify their problem early on should be offered an alternative to abstinence. "To tell everyone one size fits all is absolutely absurd," he says. "We’re going to chase people away." But Fulton Crews, director of the Center for Alcohol Studies at the University of North Carolina at Chapel Hill, says Kern’s argument is flawed. He believes moderation groups do problem drinkers a disservice because they offer the wrong motivation, luring them with the very drug to which they are addicted.
    Yet dangling a "drug carrot" — such as methadone for heroin addicts — is a common harm-reduction treatment approach for illicit drug addicts, points out William Miller, director of research at the Center on Alcoholism, Substance Abuse, and Addictions at the University of New Mexico. "Alcohol abuse and dependence comes in degrees. It’s continuous — like hypertension," says Miller. Treatment, he says, should be done in relation to the severity of the problem, as well as a patient’s willingness to work on it.

Walking the Tightrope
   According to the NIAAA, there are four times as many alcohol abusers as dependents in the United States. But federally funded research has found that 93 percent of American treatment programs are abstinence-based 12-step programs. Most American 12-step programs are modeled on Alcoholics Anonymous, a spiritual self-help group founded by Bill W. in 1935. As well as committing to abstinence, AA members admit they are powerless over alcohol. But moderation groups say they aim to help early-stage problem drinkers, who want to learn to control their alcohol intake before they become powerless or "hit bottom." Even problem drinkers may be powerless to set limits, however. Miller, the University of New Mexico researcher, discovered that many find staying within moderate drinking limits "a tightrope walk," and ultimately decide to quit drinking altogether.

Moderation as Prevention
   Genetics may also weigh in on the side of the abstinence theory. Many believe that alcoholism is an irreversible, progressive genetic disease, best treated with abstinence. Studies from the 1970s documented that alcoholism does run in families, but did not resolve whether a child learns to abuse alcohol from the home environment, or inherits that tendency, or both. But moderate drinker and founder of Drink/Link programs Donna Cornett says the genetics argument is "a misconception" that limits and labels people. "Prevention is the cornerstone of medicine," Cornett says, adding that moderation programs may help people gain control before they are trapped in a devastating cycle of alcohol abuse. In summing up 10 years of research on moderation programs, Miller says only 15 percent of people who seek help succeed in limiting their drinking in the long run. Rather than lay blame or make accusations, Kern urges, it may be more fruitful for Americans to rethink the role alcohol plays in society overall.

Single-Dose Drug for Hyperactive Kids OK'd
Associated Press, 8/2/2000

WASHINGTON -- The first single-dose form of the drug most widely used to treat attention deficit hyperactivity disorder in children won government approval yesterday. The Food and Drug Administration said it had approved use of Concerta, a form of methylphenidate. Between 4 percent and 12 percent of school-age children -- an average of about 2.5 million, mostly boys -- are believed to have the condition. Symptoms include short attention span, impulsive behavior and difficulty keeping still. Methylphenidate -- best known under the name Ritalin -- often is prescribed to increase a child's alertness. But current forms of the drug require two or three doses daily, often requiring youngsters to break up their school days with visits to the nurse's office.
    Concerta was developed by Crescendo Pharmaceuticals Corp. and will be manufactured and marketed by ALZA Corp. of Mountain View, Calif. Concerta is an extended-release formula in tablet form designed to be taken in the morning before a child leaves for school. The drug lasts 12 hours, which will avoid in-school and after-school dosing. "It makes the condition private. It eliminates the embarrassment for children," said Dan Swisher, ALZA vice president.
    Many of the symptoms of the disorder also are associated with youthful rambunctiousness, which has raised questions whether youngsters are being overdiagnosed and overdrugged. The American Academy of Pediatrics issued guidelines in May designed to aid correct diagnosis and ensure help for children. In clinical trials the most common side effects were headaches, reported by 14 percent of patients. Swisher said McNeill Consumer Healthcare is assisting in the marketing of Concerta, which should be available in two weeks. He said the price has not been determined but will be comparable to other treatments for the condition.

'Club Drug' Ecstasy's Use Soars
Raymond Hernandez, New York Times- 8/2/2000

WASHINGTON -- Drug experts warned yesterday that the use of the psychedelic drug known as Ecstasy has risen sharply, particularly among young people, raising fears that a major new front has opened in the government's efforts to curb illegal drugs. In the past 10 months, agents for the U.S. Customs Service have seized a record 8 million doses of the drug at the nation's airports and other ports of entry, official said. Federal officials gathered at a conference to discuss how to deal with the drug acknowledge that the seizures represent only a fraction of the amount of Ecstasy smuggled into the country and, in turn, channeled into major cities like New York, Los Angeles and Miami.
    Officials say the drug, which increases energy and fosters a sense of well-being, has gained wide popularity among teenagers on the nightclub circuit and at the all-night dance parties known as raves. The proliferation of the so-called "club drug" has been fueled by organized drug traffickers who authorities say have begun to expand their operations into the increasingly lucrative ecstasy market, where a single pill can be manufactured for as little as 50 cents and sold for as much as $40.
    "What was once ad-hoc smuggling among small-time dealers and users has mushroomed into organized trafficking among criminals," said Raymond Kelly, the commissioner of the Customs Service. "They have the money and the muscle to market Ecstasy beyond the club scene in New York, Miami and Los Angeles. We now see it surfacing all over the country." The White House's drug policy director, Barry McCaffrey, yesterday warned that the drug poses a serious threat to children. He cited a survey showing a sharp rise in the number of high school seniors who said they had used Ecstasy in the previous month -- from 1.5 percent in 1998 to 2.5 percent in 1999. "The use of Ecstasy has skyrocketed," he said at the conference organized by the Drug Enforcement Administration. McCaffrey said his office plans to mount a $5 million ad campaign warning against the drug.
    In what was described as a victory in the government's war against drug traffickers, Attorney General Janet Reno yesterday announced the arrest of 140 people who were accused of participating in a nationwide ring that supplied clandestine methamphetamine laboratories with the basic ingredient needed to make the drug. The arrests capped an eight-month investigation. Reno, who made the announcement at the drug conference, said federal agents had seized 10 tons of pseudoephedrine, a compound found in diet pills and nasal decongestants, but which bootleggers use to make methamphetamines, a stimulant nicknamed meth, crank, ice and speed.
    Ecstasy is a bitter white powder that is also known as MDMA, short for 3,4-methylenedioxy methamphetamine. It is a chemical variation of mescaline, a hallucinogenic drug obtained from the mescal plant, and amphetamine, a drug that stimulates the central nervous system. Ecstasy enjoyed a brief period of popularity in the early 1970s as a substitute for methylenedioxy amphetamine, or MDA, which was outlawed in the late 1960s. But it was not until the early to mid-1980s that Ecstasy gained a regular following in both Europe and the United States on the nightclub and party scene. Users are drawn by its ability to reduce inhibitions, promote euphoria, produce light hallucinations and suppress the need to eat or sleep. One pill's effects can last up to six hours, but users build up a tolerance, and an overdose can cause accelerated heartbeat, high blood pressure, fainting, muscle cramps or panic attacks.

Child Abuse, Adult Stress Linked
Erin McClam, Associated Press- 8/3/2000

ATLANTA (AP) -- Abuse in early childhood dramatically changes the brain chemistry of women for life, making them more vulnerable to anxiety disorders and more easily frustrated by stress as adults, a study suggests. Researchers said the results could lead to profound advances in treatment for depression -- for women and men. The study was published Wednesday in the Journal of the American Medical Association.  Dramatic differences in women based on whether they had been physically or sexually abused as children came to light when they were asked to speak in front of a poker-faced audience and to solve tricky math problems. In women who had been abused, a key hormone that regulates the body's response to stress responded six times as strongly as in women with no abuse history. The early trauma makes the hormone hypersensitive, researchers said.
    ''We've known for a long time that if you enrich the environment during early development, you can get critical, positive long-term effects,'' said Dr. Charles Nemeroff of Emory University, one of the study's authors. ''This is the other side of the coin, the dark side.''  Anti-depressant medication available now indirectly targets the body's hormonal response to stress. But researchers said Wednesday the new information bolstered ongoing studies on whether anti-depressants can target specific stress-reaction hormones. They also said it could help victims of abuse prevent falling into deep depression.  ''This should be beneficial is seeing whether we can reduce that sensitivity,'' said Dr. Jeffrey Newport, a study author.
    A professor from the University of Georgia disagreed with the conclusions from the Emory report. ''It's not always so,'' said Allie C. Kilpatrick, a professor of social work at the University of Georgia. ''There are so many intervening factors. Who was the person providing the abuse, how long did the abuse continue, how much force and trauma occurred at the time? All those factor in to how someone reacts later in life.'' Kilpatrick said she did a study of her own with 500 women, including some who had sexual relations with their fathers when they were children.  ''The effects were all varied,'' she said. ''There were some women who had no traumatic effects and there were women who had a lot. It all depends on those intervening variables and the resiliency of the individual.''
    The Emory study examined 49 women ages 18 to 45, dividing them into four groups by whether they had been abused as children and whether they suffered depression as adults. They were told to speak before a panel of observers who had been told not to show any reaction, and they were asked to subtract 17 from 4,000 continually.   Blood tests measured the response of cortisol and adrenocorticotropic hormone, or ACTH, two hormones closely related to another hormone called CRF that controls the body's reaction to stress. Cortisol and ACTH are much more easily measured in blood than CRF.   Researchers said they focused on women because both abuse and adult depression are more widely reported among women than men. But they said similar tests on animals have shown almost no difference in the responses of males and females. ''I have no doubt that this will be the case for both men and women,'' Nemeroff said Wednesday. ''It just highlights the importance of public education about child abuse.''

Violence Born Of Dementia Rare, Troubling
Fredrick Kunkle, Washington Post- 8/3/2000

    After crashing an armored vehicle through a picture window to get a better look inside the house where George Henry Butler was holed up with a gun, a Prince George's County SWAT team observed the 91-year-old man sweeping up the debris with a broom and dustpan and then making a sandwich, as if oblivious to the siege around him. Police said Butler--a wisp of a man known around the eastern county's farming area as a gentleman since the days when he was raising cattle--also paid no mind to the body of James Thomas Newman, 59, a beloved nephew killed when Butler apparently failed to recognize him. When ambulance workers pulled up at Butler's Leeland Road home, they found him mowing the grass a few feet away from Newman's body.
    Less than two weeks earlier, Robert Davis Jr., a 74-year-old retired postal worker, slipped behind the wheel of his 1998 gray Cadillac, drove to his sister's D.C. apartment and allegedly shot her to death with a .38-caliber handgun when she returned from the grocery store. D.C. police say Davis killed his 69-year-old sister, Lucille Shropshire, because he believed she had cast a deadly voodoo spell on him.
    Two area elderly men, each apparently gripped by powerful delusions, allegedly exploded in violence in the last two weeks, lashing out at loved ones in a fury that seemed to defy reason. But to people whose family members suffer from Alzheimer's disease or other age-related brain disorders, the bizarre flashes of unpredictable behavior are all too familiar. "Day in day out, there are Alzheimer's patients who get combative," said William E. Reichman, president of the American Association for Geriatric Psychiatry. "They get aggressive. But very often this doesn't come to the police's attention in dramatic fashion." As the illness takes its course, some patients become combative. They may scream or spit at family members and caretakers or fly into a fit of unprovoked scratching, biting or kicking, according to experts in the disease. But only in extraordinary cases does it reach a sustained level of extreme violence.
    "It's extremely rare that there would be . . . [an] outburst of violence by an Alzheimer's patient, because the cognitive abilities necessary to plan and carry out such an attack are usually impaired," said Steven Ferris, executive director of the Silberstein Aging and Dementia Research Center at the New York University School of Medicine. When police are called to intervene, Reichman said, it is usually because of a less violent confrontation. "Very commonly, a patient will turn to a spouse of 40 years and say, 'Who are you? What are you doing here? Get out of my house,' " Reichman said. "The patient may get physically aggressive and push the spouse out of the house. Or the patient may try to flee."
    It's a situation that's becoming more common. As the population ages, more and more people become susceptible to age-related dementias that befuddle and disturb a person's thinking. Alzheimer's, far and away the major cause of dementia, affects about 3 million to 4 million people. The disease strikes about one in 10 people older than 65 and nearly half of those older than 85. As baby boomers gray, the number of sufferers is expected to grow. The Chicago-based Alzheimer's Association told Congress that the number of Americans suffering from Alzheimer's will double by 2030. "These are problems that as a society we increasingly are going to have to confront," Reichman said. "There is an epidemic of Alzheimer's disease."
    Dementia describes the progressive breakdown of intellectual capabilities, often marked by confusion, chronic memory loss and personality disturbances that accompany pathological changes in the brain. Circulatory disorders that trigger mini-strokes deep inside the brain contribute to at least 15 percent of all dementia among the elderly. Another degenerative brain disorder--known as dementia with Lewy bodies--combines symptoms of Parkinson's disease and Alzheimer's but also includes hallucinations and accounts for 15 to 20 percent of the dementia cases.

Alois Alzheimer, the doctor who identified the disease that bears his name in 1906, observed signs of paranoia and aggressive behavior in some of his patients. But experts say much of the medical literature has focused on the cognitive effects of the disease.   "I think the common lore is that Alzheimer's disease is a severe form of forgetfulness," Reichman said. But studies, cited by the University of Rochester's Medical Center in a publication called "Aggression in Patients With Dementia," suggest that up to 70 percent of people diagnosed with dementia develop significant behavioral problems in the first six or seven years of illness. The report included an analysis of 222 geriatric admissions to state hospitals and found that 63 percent were violent and 8 percent used guns. Even seemingly minor episodes of violence can have deadly results. In October, an 83-year-old Illinois woman died from injuries she sustained in a nursing home when a 66-year-old dementia patient started screaming, grabbed her and shoved her into a wall. A year before that, a violent fight between two Alzheimer's patients at a Louisiana nursing home led to the death of a 79-year-old patient.
    Deirdre M. Johnston, director of forensic psychiatry at the Department of Psychiatry and Behavioral Medicine at Wake Forest University School of Medicine, has suggested that dementia could trigger violent episodes among World War II and Korean War veterans who suffered from post-traumatic stress disorder. Writing in the January issue of Journal of the American Geriatrics Society, Johnston reviewed the case of a 77-year-old World War II combat veteran who constructed a fort out of living room furniture and ambushed his wife with a .22-caliber rifle when she returned from the grocery store. The 60-year-old woman, who survived the attack, reported that her husband had suffered from nightmares and episodes of confusion leading up to the attack. Johnston said more research is needed to identify possible risk factors that may cause a person with dementia to undergo profound, potentially violent changes in behavior. "It is known that people with dementia can develop paranoid symptoms--but not everybody develops paranoid symptoms," Johnston said. "We don't know why some people with dementia become aggressive, and some people don't."
    As SWAT teams took up posts around Butler's home Friday, family members told police that he was hard of hearing and suffering from Alzheimer's, said Maj. William Richards, a member of the Prince George's County Special Operations Division. Family members also told police that Butler displayed symptoms of paranoia. He fretted about burglars and trespassers, having booby-trapped windows and doors with string to detect intruders. A few weeks earlier, family members told police, Butler fired a weapon at someone who entered his property--a report police have not been able to verify. Prince George's Police Chief John S. Farrell said Butler's age and mental state made the episode much more sensitive, likening the incident to a full-blown hostage situation or one involving children. SWAT team members worried that conventional, non-lethal tactics to subdue a gunman--such as a gun that fires rubber batons, or even police dogs--might kill Butler, just 5-feet-2 and 120 pounds. "There was a lot of restraint on the part of our officers, and there was also a lot of empathy," he said. "It was a very sad situation. He could be anyone's grandfather or father, and everyone can relate to that."
    Armed with a .22-caliber rifle and a double-barrel shotgun, Butler shot at police officers at least four times. Having ripped the telephone out of the wall, Butler also refused to make contact with police officers. "Come on in and get me!" Butler yelled, according to police. After first checking with the family to make sure that Butler had no respiratory problems, police fired teargas around 2:10 a.m. Saturday. Eighteen minutes later, however, Butler was seen opening the refrigerator. "The first hope was that this man would fall asleep and that we could all go home," said Deborah Rachlin, a psychologist who advised the police during the showdown. But Butler remained awake through the nearly 32-hour siege, and police officers marveled at his stamina. By 6:18 a.m. Saturday, police had fired 37 cartridges of teargas and pepper spray into the house--so much that when police finally entered the house, the gas still was overpowering.
    Finally, around midnight Saturday, Capt. Steven L. Long gave the go-ahead to disable Butler with a robotic water cannon used by the county's fire department to disarm suspected bombs. Viewing the robot's progress through a color video screen, Long saw Butler peek around a corner, wave at the robot and say something. "He looked like a tired, 91-year-old man," Long said. Reluctantly, Long said, he pressed the button that fired a jet of water to disable Butler. Butler was knocked to the ground and fractured a leg. Butler shed no light on his actions afterward. When police reached him around 2 a.m. and took him into custody, he told them: "I had to do it."

National Drug Czar States his Support for Methadone Clinic in Bangor
Associated Press, 8/4/2000

The national drug czar is weighing in on the controversy surrounding a methadone clinic proposed for Bangor. And he thinks it's a good idea. The stance taken by Barry R. McCaffrey puts him at odds with Bangor-area officials including Jay P. McCloskey, U.S. attorney for the district of Maine, who are concerned about an influx of heroin addicts seeking methadone treatment. In a statement requested by Maine officials including Kim Johnson, director of the Office of Substance Abuse Programs, McCaffrey reasserted the federal government's support of methadone for the treatment of heroin addiction. ''Research provides strong evidence to support methadone maintenance as the most effective treatment for heroin addiction,'' he said in the statement released Friday.
    At issue is whether methadone treatment would cut heroin addiction in the Bangor area or merely substitute one addictive drug for another. In a July 20 editorial in the Bangor Daily News, McCloskey disputes the effectiveness of methadone in treating heroin addiction, saying it ''is itself a highly addictive narcotic'' that will attract ''hard-core addicts.'' ''Those who fail on methadone maintenance, those who never intended to use (it) to stop their illegal drug use, and those who target methadone maintenance clinics to sell heroin, will addict new people to heroin,'' he says.
    McCaffrey, director of the Office of National Drug Control Policy, acknowledges that methadone is a narcotic that can be addictive. But he says it improves the health of addicts and doesn't make them ''high'' when used under the care of a physician.   He also says there is an urgent need for the clinic, citing data from the Office of Substance Abuse showing a nearly four-fold increase in Penobscot County hospital admissions for opiate or heroin use from 1995 through 1999.   McCaffrey said a study by the National Institute on Drug Abuse shows that methadone treatment cut participants' heroin use by 70 percent and their criminal activity by 57 percent, while increasing full-time employment by 24 percent. Acadia Hospital applied in January for permission to open the clinic. It would be the third clinic in the state, along with the ones in South Portland and Winslow.

Mentally Ill Children Seek Care in ERs As Services Shrink
Natasha Gural, Associated Press, 8/6/2000

NEW BRITAIN, Conn.--On a busy Friday evening, doctors, nurses and technicians at New Britain General Hospital hustle to help the heart attack, stroke and car crash victims who fill the emergency room. By 5:30 p.m., there's no space left in the 35-bed ward. But two children seeking psychiatric treatment arrive. Four hours later, there are seven people including four children using the emergency room as an outpatient psychiatric clinic. Patients include a 7-year-old boy who strips off his clothes and defecates on the floor and a 14-year-old girl who made suicide threats at school. ''We have little kids who are screaming and throwing themselves up on the walls,'' said Patti LaMonica, nurse manager and clinical nurse specialist at the emergency department.
    Across the country, a shortage of psychiatric beds and services are forcing mentally ill children into emergency rooms, nursing homes or non-psychiatric hospital wards. And in some places, including Connecticut, the stays are more than a few hours sometimes a matter of days, sometimes weeks. A national study by Yale-New Haven Children's Hospital found the number of psychiatric emergency room visits by children has increased by 59 percent over the last five years. ''It seemed like in the state of Connecticut we have a higher than expected rate, but now we know also that it's a national problem,'' said Dr. Karen Santucci, assistant professor of pediatrics at Yale Medical School and a co-author of the study. ''I don't think anyone anticipated it.'' Santucci, who presented the findings at a recent national conference in Boston, calls the problem epidemic.
    Merritt Schreiber, a clinical psychologist with the American Psychological Association, is co-chairman of a task force conducting the first phase of another national study. In cooperation with the U.S. Consumer Product Safety Commission, researchers will track 110 hospitals over 18 months. ''We really think this is a mental health crisis,'' said Schreiber, who is based in Laguna Beach, Calif. In Illinois, 11,000 mentally ill patients are living in nursing homes. A bill awaiting the governor's approval would establish statewide regulations on how nursing homes should care for the mentally ill. The Mississippi Legislature recently appropriated $17.5 million for the construction of seven new mental facilities in an effort to improve care and reduce waiting lists. Mental health officials in North Carolina want university hospitals and other private facilities to open more beds and help ease overcrowding among children at the state's four psychiatric hospitals. The federal government and medical professionals agree that hospitals are being used as outpatient psychiatric clinics. But there's a debate about the cause of the problem.
    Gary DeCarolis, chief of the Child, Adolescent and Family Branch of the U.S. Department of Health and Human Services' Center for Mental Health Services, blames the problem on a lack of insurance. Approximately 8 million American children are uninsured, he said. Dr. Gregory Fritz, professor of psychiatry at Brown University and medical director at Bradley Hospital in Providence, R.I., said dealing with young patients who have insurance is little better: There is far more paperwork for children seeking psychiatric care than for adults. ''Almost always, unless you're flagrantly malpracticing, it takes twice as long with a child,'' he said. ''We have, with tears in our eyes, shrunk our care at Bradley Hospital because we can't afford it.''
    Another cause for the increase in emergency room visits is heightened fear after the Littleton, Colo., high school shootings and similar tragedies across the country, Fritz said. ''Kids are brought in because of unruly behavior. That wouldn't have happened 15 years ago, when parents were able to manage behavior,'' he said. ''People are scared of kids.'' Dr. C. Steven Wolf, director of the New Britain emergency department, said there is also an increase in the number of children born to parents who experimented with drugs. ''These kids are having problems. The majority of the ones we see are definitely dysfunctional,'' said Wolf. ''The ones we keep are either unsafe to go back into the community or unsafe to themselves.'' New Britain also sees more than one child from the same family having problems.
    The increase in psychiatric emergency room visits burdens both hospital staff and budgets. And beds needed for medical emergencies are occupied by mentally ill children. ''Many places in California have no beds for children under 12,'' said Schreiber. ''They have to travel 100 miles or more.'' Two years ago a mentally ill child taken to the New Britain emergency room would typically stay for a maximum of 24 hours. Recently, a boy with a history of inappropriate sexual behavior was kept for two weeks. LaMonica said it costs at least $75,000 a year to call in extra nurses for one-to-one care of children. Michael Higgison, nurse manager for behavioral health at New Britain General, said it costs another $75,000 for added crisis workers. At the same time, staff must deal with parents and family members who are sometimes intrusive, impatient or troubled themselves. ''None of this stuff gets reimbursed,'' said Wolf. ''The hospital makes up the difference.''
    Placing children after emergency treatment is also a challenge. With the closure of state mental hospitals, there is a shortage of acute beds. ''The whole movement to de-institutionalize psychiatric care may have gone way too far,'' said Wolf. ''The reality is that there are some people who need to be institutionalized and they end up in prison.''  In Connecticut, child welfare officials are creating a special ward for juvenile offenders with mental illness that will emphasis treatment instead of punishment. The locked, 12-bed forensic psychiatric unit is to be open by summer.   Still, hospital officials feel the effects of the shortfall. ''It's cost-shifting onto the hospitals,'' said Wolf. ''Before you could rob Peter and pay Paul. Now there's no Paul.'"

Compelling New Evidence on the Benefits of Quitting Smoking
Thomas H. Maugh II, Los Angeles Times- 8/7/2000

You've heard plenty about the health benefits of quitting smoking. Now British researchers have provided more compelling evidence of just how significant those benefits can be. Researchers at Oxford University found that people who quit smoking before age 35 can reduce their risk of developing lung cancer by more than 90%. And giving up smoking even late in life eliminates most of the risk. While previous studies of quitting have shown the effect on lung cancer rates can be dramatic, the Oxford report in Saturday's British Medical Journal (http://www.bmj.com) gives the clearest evidence yet.
    The project, led by Sir Richard Peto, also provides the first prediction of the number of tobacco-related deaths that will occur worldwide in the next 100 years if smoking patterns persist--1 billion deaths, contrasted with 100 million in the last century. Peto's research found there already are 1 billion smokers in the world and that, by 2030, another billion or so young adults will have started to smoke. If current smoking patterns continue, tobacco-related deaths worldwide will rise from 4 million a year now to about 10 million a year around 2030, an increase of about 100 million a decade, he estimated. If trends continue, he predicted that about 15% of all adult deaths worldwide in the second half of the 21st century will be due to tobacco.
    No matter how early in life a smoker quits, some of the damage done is irreversible and the risk of lung cancer never declines to normal. Recent research has shown that starting smoking before age 18 is particularly harmful to the lungs. The Oxford study found that only 2% of those who quit by age 30 developed the disease by age 75, compared to a 0.4% chance for people who have never smoked. It also found that 10% of those who quit at 60 will die of lung cancer, and that continuing to smoke into old age results in a 16% risk.

Abuse Tied to Stress and Depression in Women
Los Angeles Times- 8/7/2000

Women who were sexually or physically abused as children have abnormally elevated hormonal responses to stress, a chemical imbalance that predisposes them to mood and anxiety disorders, according to researchers from Emory University in Atlanta. The scars of their childhood persist throughout life, according to Dr. Charles B. Nemeroff, leaving them vulnerable to a wide variety of psychiatric disorders. The Emory team studied 49 adult women, age 18 to 45 years, who were divided into four groups: those who were sexually or physically abused as children and were diagnosed with depression in adulthood; those who were abused in childhood but had not developed depression; depressed women who had not suffered child abuse; and a control group of women with no history of either abuse or depression.
    The women underwent a variety of stress tests during which levels of hormones, such as cortisol and ACTH, were measured. The researchers reported in Wednesday's Journal of the American Medical Assn. (http://jama.ama-assn.org) that both groups of women who were abused in childhood showed exaggerated stress responses, with those who were depressed showing the greatest increase. On some measures, their output of stress hormones was six times as great as that of the control group. The women who were depressed but had no history of abuse showed the same hormone response as the control group, however. The team is now looking for ways to minimize that elevated response.

No Prompt Payment: HMOs May Not Be Paying Your Doctor and Hospital on Time
Steve Osunsami, ABC News- 08/08/2000

Nine-year-old Caitlyn Chipps needs weekly physical therapy to treat her cerebral palsy. Her father, a Florida sheriff’s deputy, believed he had a great health plan to pay for it. Six years ago, the Chipps family made an alarming discovery. Their HMO was three months behind on Caitlyn’s expenses and was now leaving the family with nearly $30,000 in unpaid bills. "We refinanced the home, and the savings we had were depleted," says Caitlyn’s father, Mark Chipps. "[We used] Savings Bonds," says his wife. "I cashed in some. I had some stock that my grandparents had left me."

Industry Standard?
Across the country, patients are now discovering what doctors and hospitals say is industry standard: the slow pay.
Today, Atlanta pediatrician Dr. Joy Maxey is out thousands of dollars — money that would buy vaccines and office supplies. "I could spend a lot more time with my patients," says Maxey, "if I did not have to spend time chasing down paper, chasing down unpaid insurance claims." St. Joseph’s Hospital, a nonprofit institution, is waiting on $13 million in unpaid claims. Its nuns need the money to run mobile health clinics, which they use to help heal the homeless. "We could serve many, many more people," says Sister Angela Ebberwein. Hospitals are forced to chase HMOs for payment, but all they get is the run around. "We contact them and no one knows what we’re speaking about," says St. Joseph’s Hospital Claims Administrator Gerri Lee-Sellers. "We ask for a supervisor, and they tell us no supervisor is available. We ask to leave a message, we’re never contacted back."

States Attempt to Enforce
In the past few years, 40 states have passed laws requiring HMOs to speed things up and to pay bills within 15 to 45 days. Enforcing those laws is not easy. The insurance commissioner in Georgia has even tried fines, totaling millions of dollars, with little success. "And keep in mind these are bills," says John Oxendine of the Georgia Insurance Commissioner. "We’re talking about bills they just plain, out-and-out haven’t paid." Health care providers have long argued that HMOs systematically take their time paying their bills, to improve their cash flow. The longer bills aren’t paid, the more interest these companies earn from that money. Wade Harper is a former United Health Care executive who was fired after writing a memo criticizing his former company for slow pays. Harper recalls practices such as, "subjecting large claims to certain types of medical review, even if they’ve already been approved." He says United would instantly return claims with simple errors to profit from the delay. "There are practices being employed by certain managed care organizations that are immoral, illegal and they should be stopped," Harper says.

HMOs Deny Charges
Managed care companies deny all charges. "If the provider would instead send in a claim with the correct amount billed on it, we could pay it much faster," says Gay Ann Williams, an industry spokesperson, who blames health care providers who provide incorrect information, bill twice for the same procedure and are behind the times.
"If the claims come in electronically, most health plans tell me the claims, if they’re clean, could easily be paid in 10 days," Williams says. "That’s a lie," says Mark Chipps, "they’re lying." The Chipps family doesn’t believe a word. Caitlyn’s father sued Humana health care for not paying bills and eventually cutting Caitlyn’s coverage. After five long years, he was awarded $79 million, a rare victory. Federal law allows him to sue, because he’s a government worker. For most everyone else, "the check is in the mail."

Suspect in Deputy's Murder Troubled by Mental Illness
Paul Shukovsky, Seattle Post-Intelligencer- 08/08/2000

PORT ANGELES -- The man accused of murdering a sheriff's deputy had been committed to a mental ward at least twice, but police were powerless to keep him hospitalized, the Clallam County sheriff said yesterday. Thomas Roberts, who may face the death penalty in the murder case, was well-known to police long before Saturday's fatal shooting of Deputy Wally Davis. In the past 13 months, police had responded to Roberts' home eight times -- either because neighbors were frightened by his behavior or because Roberts himself called 911, authorities said.
    On a number of occasions, mental health professionals were called to commit Roberts, but police were able to calm him down by the time the professionals arrived, said Joe Hawe, the Clallam County sheriff. A person can refuse treatment if he is not a danger to himself or others. Yesterday, a judge ordered that Roberts be held without bail to face a charge of aggravated first-degree murder in Saturday's shooting. Although the maximum penalty is death, prosecutors have not decided whether to seek execution.
    Meanwhile, in this tightknit little city tucked between the Olympic Mountains and the Strait of Juan de Fuca, shock began to give way to sorrow. The depth of grief was reflected by an impromptu altar outside the courthouse where Roberts appeared. After adding a bouquet of flowers to a growing collection, Tammy Woolridge reflected that even quiet little Port Angeles is not immune from evil. "It just shows society is changing and becoming more violent," she said. But the tools used to deal with such violence failed in the Roberts case, Sheriff Joe Hawe said.
    Once last year, Hawe said, mental-health professionals were ready to commit Roberts.  Then, Hawe said, "family members said he was back on (medications) and OK. All of the sudden they lost the leverage to commit." Although Roberts' family intervened in that instance, his mother had tried for years to have her son committed, said Hawe, who spoke with the woman Sunday. She said her son, now 53, has been ill since he was 19.
    Dan Zavon, executive director Peninsula Mental Health in Port Angeles, agreed that the mentally ill face huge, unmet needs. "We need a crisis facility here. There is none," he said. "We need more case managers. We need funding for medication for those people who don't have money to buy it." Like others in the city, Roberts' neighbor, Mary Huffman was also well aware of Roberts' illness. "He often wandered through the neighborhood naked and armed with a gun," she said. Huffman said Roberts shot three of her cats. He also talked about wanting to have sex with children, she said. Another neighbor, Tom Kaufmann, obtained anti-harassment orders against Roberts but still had problems. He said he and his wife often heard gunshots coming from Roberts' house. And recently, he said, Roberts threatened to kill a couple of 12-year-old boys for trying to cross a bridge. "What really saddens me is that they should have taken this man's guns away from him before this happened," he said. "I really think they need to change some laws."
    It was Kaufmann who reported a domestic disturbance at Roberts' home Saturday, the call that led to Davis' death.  Davis had dealt with Roberts before. Fellow deputies described him as especially sensitive in dealing with the mentally ill. But according to Hawe, Davis never had a chance to calm Roberts this time. He was ambushed as soon as he arrived, police and prosecutors charged. "He was blown away the minute he came up to the door," Hawe said. "He didn't even have a chance to get his gun out." On Sunday, after a 25-hour standoff, Roberts finally surrendered after Seattle SWAT team members fired tear gas into a crawl space where Roberts had been hiding. A few miles away from his house, Roberts shuffled to his courtroom seat yesterday in leg irons. He called himself "his majesty, the pharaoh" in addressing the judge. Roberts' appointed public defender declined comment.
    On Thursday, as many as 2,000 people, including law enforcement officers from throughout the state, are expected to attend a public memorial for Davis at 2 p.m. at Civic Field in Port Angeles. A testament to the way Davis touched people's lives came from an unlikely source: a man Davis once arrested. Ron Berry said Davis "would try to talk things out before he arrested you. He tried to make things easy. He would come by my house and ask how I was doing."
    Now Hawe hopes to give meaning to Davis' death by fighting for adequate treatment for the mentally ill. "If we are not going to put these people in a place where they are protected and society is protected from them," he said, "we have to provide money to give them medicine and make sure they take it." Hawe also pledged to investigate exactly why Roberts was not committed at the time he allegedly killed Davis. Yesterday, he did not know why the mentally ill man was released from his prior involuntary commitments. "The way the system is set up, individual rights of mentally ill people take precedence" over community safety, he said. He added that police officers are not equipped to act as mental-health professionals themselves. But Zavon said the difficult issue of commitment needs careful debate. "There is no way," he said, "to predict dangerousness with accuracy."

A Third of College Students Continue to Use Tobacco
Melissa Schorr, ABC News- 8/8/2000

BOSTON--Despite crusades and campaigns encouraging young people not to take up smoking, a third are currently using tobacco products, a number greater than previously believed, researchers said today. Previous research examined cigarette smoking in college students, but failed to ask about the use of other tobacco products, such as cigars, which added significantly to the findings and may give researchers new insights into how to target smoking on campus. Researchers from the Harvard School of Public Health surveyed more than 14,000 students at 119 colleges nationwide, asking them to report on their lifetime use of tobacco. The results were announced today at the "World Conference on Tobacco or Health" in Chicago and were also published in a special issue of the Journal of the American Medical Association devoted to tobacco research.

Still Smoking
    A third of the students said they had used a tobacco product — cigarettes, chewing tobacco and increasingly, cigars — in the last four weeks, indicating they were current users, and nearly half of the students admitted they had used tobacco in the past year. Between 1993 and 1997, the number of U.S. college students who smoked cigarettes increased from 22 percent to 28 percent, the study reports. Researchers suspected that use of other tobacco products, such as cigars, was on the rise as well, but had never asked the question. Their suspicions proved correct. In the current study, 23 percent of college students said they had smoked a cigar in the last year and 9 percent reported they were current cigar users, while only 3.7 percent said they currently use chewing tobacco and 1.2 percent said they currently smoke pipes. Those findings brought the total tobacco use up to 33 percent.

Playing With Fire?
    Researchers blamed the rise in cigar use among young adults on the cigar industry’s successful marketing push in the early ’90s, which made cigar bars and magazines trendy. "College students are playing with fire, putting themselves at risk of a lifelong addiction to nicotine," says lead author Dr. Nancy Rigotti, director of tobacco research and treatment at Massachusetts General Hospital in Boston. Men and women now smoke cigarettes in equal numbers, but because men tend to use cigars and chewing tobacco more often than women, the percentage of male smokers is higher overall. Whether women will close the gender gap in cigars and chewing tobacco remains a concern, researchers say.
Although the tobacco industry repeatedly insists it only markets its wares to those of legal age, the students reported the average age they tried their first cigarette was 14, and the average age they’d first tried a cigar was 17 for boys and 18 for girls. On the bright side, cigarette use by college students, while on the rise during the mid ’90s, seems to have stabilized from 1997 to 1999 at about 28 percent. And a third of the current cigarette smokers said they do not smoke every day, indicating they are only casual users.

Risky Business
    Not surprisingly, the study found that tobacco use is higher among binge drinkers — the old " I-only-smoke-when-I-drink" excuse — and among students who have multiple sex partners or have what researchers dub "a strong party orientation." "Use of tobacco products goes along with a generally riskier lifestyle," Rigotti says. The researchers are advocating that all buildings on college campuses should go completely smoke-free, banning smoking from dorm rooms and common living areas. "This would protect non-smokers from secondhand smoke and reduce the visibility of smoking on campus," Rigotti says. Current policy at colleges varies. At Harvard University in Cambridge, Mass., for example, the online student handbook notes that smoking is banned in all common areas and student bedrooms. But several colleges still allow smoking in individual dorm rooms. At Columbia University in New York City, for example, current policy allows smoking in designated dorm rooms with roommate consent.  "Tobacco use is rising among young Americans," Rigotti warns. "If this trend continues, it threatens to reverse the decline in U.S. adult smoking that we have witnessed over the past half-century."

Tobacco Experts Convene
C H I C A G O — Thousands of health and other professionals have gathered this week to tackle a long-standing question: What’s the best way to get people to quit smoking? It is a daunting task for officials meeting in Chicago for the 11th World Conference on Tobacco. Officials at the conference say smoking will contribute to the worldwide deaths of 4 million people this year. If unchecked, they say those deaths will increase to 10 million in 2030. Dr. Gro Harlem Brundtland told a room full of the conference’s 4,500 attendees that such figures should motivate "a truly global debate" on the tobacco issue. Brundtland, director-general of the World Health Organization, also called for a unified anti-smoking approach: high cigarette taxes bolstered by heavy-hitting anti-smoking ads, a total ban on smoking in public places and increased access to programs that help smokers quit. "We know what works," said Brundtland, a Norwegian who’s also a conference chairwoman. And by doing what works, she said, "we save lives."
    Already, some countries are taking action. In Norway, for example, a pack of cigarettes costs more than $7, mostly due to taxes. In Canada, federal law now requires cigarettes packs to carry graphic images, including photos of a smoker’s deteriorated lungs, heart or gums. In October, Brundtland says the WHO also plans to start work on a treaty for its 190 member countries. The treaty will seek to prevent the sale of cheaper, smuggled cigarettes and share anti-smoking campaigns and education materials with developing countries — which account for about 70 percent of smoking-related deaths. An American Cancer Society study prepared for the conference found that, of 196 countries monitored, about half prohibit the sale of cigarettes to minors and only about a third have access to pharmaceutical treatments for nicotine dependence.
    Meanwhile, about a third of those countries have health warnings on their cigarette packs, with Canada’s among the most graphic. "We feel the cigarette pack is the number one tool to reaching smokers and their families," said Norman Brown, director of regulations and compliance for that country’s Tobacco Control Programme.
Brown said Canadian health officials decided to use the "larger, full-color and graphic" images because written warnings on cigarette packs are beginning to lose their effect. He also said that, while the number of smoking Canadians has dropped in the last five years, the number of young people who’ve start smoking has increased slightly. Brown plans to meet this week in Chicago with officials from the United States and Australia who have expressed interest in duplicating the campaign.
    But not everyone at the conference believes high cigarette taxes and anti-smoking campaigns will be enough to get people to stop smoking. At a conference panel Monday, Lars Ramstrom, director of the Institute for Tobacco Studies in Sweden, said chewing tobacco may help hard-core smokers quit. Ramstrom said a study found that "snus" — ;a moist, unfermented chewing tobacco that is popular in the Scandinavian country — helped 4 to 5 percent of smokers quit. He said early studies also indicate that smoking tobacco is much more harmful to one’s health than chewing it. Some health professionals, especially those who treat tobacco chewers for cancers of the mouth, were troubled by Ramstrom’s suggestion. But he stood by it, saying it was unrealistic to think everyone can quit "cold turkey." "The real world shows us that’s not the only way to go," he said.

A Lawsuit Alleges Attention Deficit Disorder is Over-Diagnosed
Ephrat Livni, ABC News- 8/9/2000

NEW YORK--Nestor Sosa spent three years and $40,000 fighting to get his son off Ritalin. Ritalin, an amphetamine-like drug used to treat ADD, or attention deficit disorder, is prescribed to an estimated 4 million American schoolchildren each year. But Sosa thought his son shouldn’t be among them. The boy’s mother and school both felt Ritalin, which helps some kids to concentrate, would assist the youngster in overcoming some of his learning difficulties. Sosa, of Chatsworth, Calif., believes his son, now 14, never had ADD. He thinks the boy was a victim of a trend in this country to diagnose normal juvenile behavior as a disease. "ADD is like a catchall," says Sosa, who took his ex-wife to court over their son’s Ritalin use. "Nobody could give me a straight answer and nobody could define ADD." Sosa’s conflict with well-meaning doctors and educators reflects a growing controversy about whether ADD and its variant, attention deficit (hyperactivity) disorder, are being over-diagnosed — causing children to be drugged for no reason.

Conspiracy to Over-Diagnose?
    In fact, a class-action lawsuit against Ritalin manufacturer Novartis, the American Psychiatric Association and the parents’ group Children and Adults with Attention Deficit Disorder (CHADD) alleges the company fraudulently over-promoted the diagnosis of ADD/ADHD in collusion with the two organizations to boost drug sales.   The action, filed in a state court in Brownsville, Texas, in May, seeks unspecified damages against Novartis, charging, among other things, that the Basel, Switzerland-based company failed to adequately warn the public of Ritalin’s impact on children’s cardio-vascular and nervous systems. Several hundred Texas parents have signed on as plaintiffs, but are not discussing the case with the press. Sosa is not involved in the lawsuit.
    The suit alleges that the American Psychiatric Association has expanded the definition of ADD/ADHD in the Diagnostic and Statistical Manual IV, the handbook of psychiatric diseases, over time so that more and more children would fall into this category. Additionally, it claims the drug company encourages the diagnosis of ADD/ADHD and its treatment with Ritalin by economically supporting both CHADD and the psychiatric association. In a written statement to ABCNEWS.com regarding these allegations, the company said it would defend itself vigorously against the suit, adding: "Novartis has supported educational programs sponsored by the American Psychiatric Association, as is standard industry practice, and as do most pharmaceutical companies with a therapy in the psychiatric area. The notion that Novartis improperly influenced the APA has no merit."

Number of Cases Increasing
    As for CHADD, the company said: "Novartis is proud to help CHADD and other credible third-party organizations that provide valuable information to many people. Novartis rejects the notion that these unrestricted educational grants to credible third parties creates improper influence upon them."  CHADD declined to comment on the case.
    Statistics do show an increase in the number of cases of ADD/ADHD and a rise in drug prescriptions. Attention deficit (hyperactivity) disorder is now the most commonly diagnosed behavioral disorder of childhood, affecting 10 percent of school-age children in the United States, according to the a 1999 Drug Enforcement Administration report. IMS Health, a health information company in Plymouth Meeting, Pa., reports that prescription rates for Ritalin have increased 390 percent in the last five years as of June.
    Pointing to "a mountain of scientific evidence" to refute the charges that it helped Novartis manufacture the diagnosis for ADD/ADHD, the APA called the allegations "ludicrous and totally false." "The diagnostic criteria in DSM-IV were extensively tested for validity and reliability in field trials funded through a research grant from the National Institute of Mental Health," the APA said in a statement. It says it develops its diagnostic manual based on the research and input of thousands of experts from around the world. Representatives declined to comment further on the case.

Defining Diagnosis
   Psychiatrists say the proper diagnosis of ADD/ADHD takes time and careful evaluation. Dr. David Fassler, chairman of the Council on Children, Adolescents and Their Families for the APA, emphasizes it is important to ensure a child has received a comprehensive professional evaluation, including family, school and medical history, before being diagnosed with a disorder. Some critics blame the diagnosis’ popularity on the "pencil/paper diagnostic exam," a form that teachers or other school authorities fill out. Schools routinely base recommendations for further medical evaluation on the test, but critics say it is too subjective and inclusive. Behaviors listed on it should be considered normal, says psychiatrist Dr. Peter R. Breggin, the author of Talking Back to Ritalin and Reclaiming Our Children. Breggin is a medical consultant to the plaintiffs’s attorneys in the lawsuit.
Behaviors on the diagnostic exam for ADD include:
"Often fails to give close attention to details or makes careless mistakes in school work."
"Often avoids, dislikes, or is reluctant to engage in tasks that require mental effort (such as schoolwork or homework)."
Symptoms for ADHD on the list include:
"Often fidgets with hands or feet or squirms in seat."
"Often has difficulty playing or engaging in leisure activities quietly."
    Dr. Fred Baughman, an El Cajon, Calif., neurobiologist, has been following ADD/ADHD research for 20 years and believes the disorders are "a colossal fraud." He says there is no evidence of a physical or chemical abnormality in people diagnosed with ADD or ADHD. But many other disorders, including Alzheimer’s, do not have objective markers that show up in a physical examination or a blood or urine sample. "It’s no more subjective than any other medical disease," says Fassler.

Calls for a Closer Look
   The rise in the use of Ritalin has federal agencies worried. In March, the American Academy of Pediatrics announced a plan to further study the issue. The DEA held a conference in 1996 on stimulant use in the treatment of ADD/ADHD. "There is a legitimate place for these drugs," Gene Haislip, deputy assistant administrator of the DEA’s Office of Diversion Control, concluded in a report about the meeting. But Haislip warned parents to protect their children by informing themselves. "Regrettably, much of the literature and promotion of the drug in recent years has ignored or understated the potency and abuse potential of methylphenidate and Ritalin," he wrote. "This appears to have misled many physicians into prescribing the drug as a quick fix for problems of school and behavior."
    But for parents who say Ritalin has helped their children, the proof is on the report card. Eileen Lee, a pediatric physical therapist in Reading, Mass., says her daughter’s grades went up significantly after she was put on Ritalin.
Now 14, the girl has been on the drug for about two years. In combination with years of counseling, Ritalin has also helped curb her aggressive behavior, allowing the girl to function better in social situations, Lee says.
"Ritalin wasn’t a cure, but it helped to take the edge off," Lee says. But Sosa, who eventually won the legal battle with his ex-wife to take their son off Ritalin, the issue goes beyond grades and behavior. "This is almost like a violation of [children’s] human rights," he says.

Plight of Mentally Ill Inmates Remains State Secret
John P. McAlpin, Associated Press- 8/10/2000

TRENTON, N.J.-- A schizophrenic inmate in solitary confinement set himself on fire, spent months in a hospital burn unit and was then ordered back to a specially designed cell, where he remained alone, untreated and at times incoherent for three years. A 16-year-old inmate lived most of five years in isolation, his multiple mental illnesses treated with medication. The official penalties for repeated suicide attempts: being shackled into ''restraining chairs'', ordered naked into ''strip cells'' or locked in a ''dry cell'', a room without lights or running water where urine and feces were removed once a week.
    A public advocacy group reported these cases and others in a class-action lawsuit seeking better treatment for mentally ill state prison inmates. Prisoners whose illnesses caused outbursts or other behavioral problems were disciplined, not treated, the lawsuit alleged. New Jersey officials last year agreed to almost all demands in the lawsuit, promising changes at every level in the system treating mentally ill inmates. The Department of Corrections said it would hire more staff, offer better training, build treatment facilities and rewrite disciplinary procedures to consider an inmate's illness.
    But the outside review of treatment programs required by the deal that settled the lawsuit is shrouded in court-sanctioned secrecy. The suit was filed by the Inmate Advocacy Clinic at Seton Hall University Law School.  ''New Jersey might have had one of the worst records on inmate treatment in the country. Now it might be leading the way in terms of things they agreed to do. We don't know,'' said lawyer Bruce Rosen representing the New York-based Human Rights Watch. The Whitman administration paid $16 million this year for improvements ordered by the settlement and budgeted $17.7 million for the next fiscal year. The state also agreed to pay $1.2 million in legal fees, according to a copy of the settlement summary.
    Both sides said a forensic psychiatrist would visit state prisons four times a year, interview inmates and review procedures. According to court documents, his reports determine if the state is complying with the agreement.  Last month, Human Rights Watch asked a federal court to allow those progress reports to be inspected by the public as well. U.S. Magistrate Judge John Hughes plans to issue his ruling this month on that request. The settlement, which Hughes approved, allows those reports to be seen only by the state, the private contractor that provides inmate medical services and the Inmate Advocacy Clinic, all original parties in the lawsuit. Human Rights Watch plans to include New Jersey in its national review of prisons and mental health treatments, Rosen said. ''We see nothing. We get nothing. All we get is a stone wall,'' he said.
    Other inmate advocate groups disagree with the fight to keep the status reports private. ''How are you going to monitor compliance if you keep it under wraps,'' said Ed Martone of the Association on Correction.  There is a need to preserve patient confidentiality, but taxpayers who paid for the improvements deserve to know how the money is spent, Martone said. So do legislators who approved budget increases. ''By the same token, we're not talking about two companies involved in a copyright spat. We're talking about public policy. We're talking about human beings who are wards of the state,'' Martone said. Lawyer Patricia Perlmutter, who headed the fight for the Inmate Advocacy Clinic, could not be reached for comment. A secretary said she is on sabbatical. But after the July 17 court hearing, Perlmutter said, ''We continue to have tremendous concerns.'' A spokeswoman for Attorney General John J. Farmer Jr. said the confidentiality agreement is simply part of the settlement. ''Both sides agreed to it. It was settled that way,'' Katherine Lyons said.
    Corrections officials estimate 2,600 inmates - approximately 10 percent of the total prison population - are being treated for some form of mental illness. Since July 1999, the state has built treatment centers at four prisons to treat inmates as well as 418 new cells, said chief of staff Mary Ellen Bolton. Guards now get 10 hours of training, with half a day dedicated to dealing with mentally ill prisoners, she said. ''People have to be given the appropriate level of care for their particular disease,'' she said. Some inmates are still ordered to ''administrative segregation'' or solitary confinement, Bolton said. If inmates are ill, they are supervised by medical staff, she said.  Bolton said she could not ''confirm or substantiate any allegations made'' before she and Commissioner Jack Terhune took office in 1998. Supervisors know the changes are working, Bolton said. Assaults on staff members are down 37 percent since the settlement and many of the solitary confinement cells are empty, she said.  But an independent assessment from the forensic psychiatrist is not available, Bolton said. That review could continue for at least a year, she said. ''Until we get through that transition period, we really need to be cooperating with all the requirements of the settlement,'' Bolton said.

Lilly Set Back by Appeals Court Ruling on Prozac
Reuters, 8/10/2000

INDIANAPOLIS-- Eli Lilly and Co. says a U.S. appeals court reversed a decision that had given the company's blockbuster antidepressant drug Prozac patent protection through 2003, raising the likelihood for early generic competition and sending Lilly's stock tumbling. In a victory for Barr Laboratories Inc. and other generic drug makers, the court overturned a ruling by the U.S. District Court for the Southern District of Indiana that allowed Lilly to hold two patents on the world's No. 1 antidepressant -- with global sales of $2.6 billion in 1999. The second patent would have effectively extended protection against generic forms of Prozac after the first expires in 2001. `This is by far their No. 1 drug,'' said analyst Neil Sweig of Ryan, Beck-Southeast, referring to Lilly's Prozac. ``This is a significant negative event for Lilly.''
    Assuming a ruling by a U.S. appeals court holds, Indianapolis-based Eli Lilly forecast single-digit earnings per share growth in 2001 and 2002, and said it expected that the entry of generic versions of Prozac into the market to have a financial impact spreading over the two calendar years. ``We'll likely see earnings declines in the second half of 2001 and the first half of 2002,'' Charles Golden, executive vice president and chief financial officer, said in a release. Earnings per share had grown by 18 percent in 1999. After the news, Lilly shares dropped 33-9/16, or 31 percent, to close at 75, on the New York Stock Exchange, shedding about $37 billion in market capitalization. The issue, the biggest loser on the NYSE, had rallied from around 54 in early March to a record intraday high of 108-15/16 on Tuesday.
    Barr Laboratories shares gained 25-11/16, or 55 percent, to close at 72-1/8 on the NYSE, a record high.  The news also sent shares of Sepracor reeling, down 23-3/8, or 18 percent, to 106-1/8 on the Nasdaq. Lilly has a licensing agreement to develop and sell Sepracor's R-fluoxetine, a variation of Prozac that is undergoing clinical trials and is believed to have fewer side effects. Losses spilled over into shares of Forest Laboratories Inc., which skidded 27 to close at 87-1/2, amid fears that sales of its antidepressant Celexa also could be threatened by the court ruling and generic competition. Prozac has lost market share to Celexa. In a separate decision, the federal court affirmed the 2001 patent on Prozac.

Vows To Appeal
The drug was introduced in 1988 as a new class of antidepressants that work by increasing the brain's supply of serotonin, a neurotransmitter that allows nerve cells in the brain to communicate with each other. Lilly, which also makes the widely prescribed osteoporosis drug Evista and Zyprexa for treating schizophrenia, recorded worldwide Prozac sales of $2.61 billion, down 7 percent from 1998, led by a drop in sales in the United States. The decline reflects growing competition from newer antidepressants.  On Wednesday, Lilly vowed to appeal the ruling against its 2003 patent. ``Clearly, we are disappointed with the appellate court's ruling, and I have instructed our attorneys to appeal the decision,'' Sidney Taurel, Lilly's chairman, president and chief executive, said in a statement. ``Without appeal, we'd expect generic competition by August 2001 at the very earliest,'' Lilly spokesman Ed West added. ``But we do plan to appeal.''
    The rulings clear the way for generic Prozac to enter into the U.S. market sooner than mid-2004, which was when analysts had expected generic competition, analyst Len Yaffe of Bank of America said. He estimated Prozac sales would drop to about $2.5 billion this year. During a conference call with Wall Street analysts and reporters, Lilly executives tried to turn attention to its other drugs and drugs in development. ``We continue to be very optimistic regarding our pipeline.... We have the strongest pipeline in the industry,'' Taurel told the conference call. ``And we'll do everything necessary to take full advantage of that pipeline.'' Yaffe, who upgraded his investment rating on Lilly to ``buy'' from ``market performer'' after the sell-off, said: ``This is a significant issue for Lilly, but one has to remember Lilly has many other (drugs) that are doing exceptionally well.''

Generic Floodgates Poised To Open
    In a statement, Barr Laboratories pegged February 2001 as the earliest date for generic competition. ``We are pleased that after a thorough review the court recognizes the importance of restricting add-on patents solely designed to extend the patent life of blockbuster drugs at the expense of consumers,'' Bruce Downey, Barr's chairman and CEO, said in a statement. In 2002, analyst Sweig said, ``the generic floodgates will open.'' Lilly is looking at having its modified version of Prozac with Sepracor out late in 2002, if everything goes well during the clinical trial, Sweig said. Looking ahead, Golden said strong underlying growth of the products that were launched more recently, coupled with the expected introduced of a number of new products and indications in 2001 and 2002, would lead to a rebound in earnings growth in the second half of 2002. Analyst Robert Kirby of Edward Jones added, ``In the short term, providing this ruling doesn't get overturned, Lilly's Prozac is going to lose a lot of sales over the next two years. But five or six years from now, Lilly should reward investors.''

Cheaper, Generic Prozac to Hit Market in 2001
Phil Galewitz, Associated Press, 8/10/2000

NEW YORK--Consumers will be able to buy a less expensive, generic form of Prozac by next August after a federal court ruling dashed Eli Lilly and Co.'s hopes of extending the patent protection on its blockbuster anti-depressant.  The court's decision on Wednesday is a major blow to Lilly, which counts on Prozac for about a quarter of its total sales and had sought to defend itself from competitors for two more years. The ruling is beneficial not only for consumers, but for generic drugmaker Barr Laboratories Inc., which has battled Lilly over its Prozac patent since 1996. Barr said the court ruling which overturned a lower court's decision that kept Prozac's patent alive until December 2003 should clear the way for it to make a generic Prozac by February. But Lilly is expected to apply for, and receive, a six-month extension by agreeing to test the drug in children. ''We are very pleased with the decision,'' said Bruce Downey, Barr's chairman and chief executive. He promised the generic version of Prozac will be substantially cheaper than the brand-name version.
    Typically, generics are at least half the price of brand-name equivalents, which can result in brand-name drugs losing about 80 percent of their sales within two years. Prozac costs about $2.63 a day. It has lost market share in recent years to Pfizer's Zoloft and SmithKline's Paxil. Earlier this year, Prozac lost its status as the top-selling anti-depressant in the United States in terms of new prescriptions, falling behind both drugs. Still, Prozac still had $2.6 billion in sales in 1999, about $2 billion of which was in the United States.
    Lilly plans to appeal the ruling from the Washington-based U.S. Court of Appeals. If the ruling stands, Lilly said its earnings will decline significantly in the second half of next year and in 2002. ''While we're clearly disappointed with today's ruling and plan to appeal it, we nonetheless are thoroughly prepared to implement a comprehensive contingency plan,'' said Charles Golden, Lilly's executive vice president and chief financial officer. Lilly's plan includes getting U.S. approval to launch a next generation Prozac pill and introducing the first-ever drug to treat sepsis, a deadly blood infection. Lilly also hopes to expand sales of several drugs, including the anti-psychotic Zyprexa and diabetes drug Actos.