Asperger's: Information and Advice
A Book Review of "The Oasis Guide to Asperger Syndrome" by Patricia R. Bashe & Barbara L. Kirby
David Corcoran, New York Times- 11/13/2001

As recently as a decade ago, this was a fairly typical set of responses to a child with the odd constellation of behaviors caused by Asperger syndrome, a neurological disorder: The preschool teacher, noting the boy's refusal to sit in a circle and his obsession with electrical outlets and switches, suggested there might be learning problems. The pediatric neurologist said he had attention deficit disorder. A psychologist thought he needed behavior modification. The psychiatrist hired by the local school system thought he was autistic and darkly suggested that he might be better off in an institution. And the parents--my wife and I--felt bewildered, frightened and alone. If only we'd had this book. While hardly the first to deal with Asperger's--a disorder so widely chronicled in recent years that it threatens to become a fad diagnosis--it is surely one of the best.
    Asperger syndrome is thought to be a form of autism. Though it was first identified in 1944, few Americans had even heard of it until 50 years later, when it was finally listed in the American Psychiatric Association's diagnostic manual--a surprising time lag, considering that experts now think it occurs in 1 out of 300 people, or at least half a million Americans.  Asperger's is characterized by social awkwardness, extreme literal-mindedness and, most conspicuous, a pedantic, talky fixation on arcane topics--Pokemon, dinosaurs, train schedules--often to the exclusion of nearly everything else. It was this trait that led Hans Asperger, the Viennese psychiatrist who first identified the disorder , to call it "the little professor" syndrome.
    The authors of this book are not specialists, except in the sense that my wife and I are: each has a son with Asperger's, which strikes boys at a rate 4 to 10 times as high as the rate in girls. But with prodigious research and the help of their six-year-old Web site for parents, Oasis (for Online Asperger Syndrome Information and Support, at www.aspergersyndrome.org), they have assembled a remarkable amount of information and presented it in such a levelheaded, clear-eyed manner that their guide could be a model for any self-help book.
    On paper, Asperger's Syndrome  sounds harmless, quirky, even vaguely charming. But the "Oasis Guide" is admirably free of sugarcoating and inspirational cant. In response to those who call Aspergers's a mild form of autism, they quote a mother who tartly points out, "My son doesn't have mild anything." As they write, in perhaps the book's most crucial sentence, "It is important to remember that Asperger syndrome is a serious, lifelong disability that requires individualized expert intervention and should be treated as such."
    With help, children with the syndrome can grow into successful adults, though there are few if any studies to indicate how many do so. The book is very good on what interventions are available and how parents can go about finding them. It devotes chapters to medications, which cannot cure Asperger's but may be effective against related disorders, like attention deficit and depression; dealing with school authorities, who are required by federal law to provide appropriate services to every child with disabilities; and teaching social skills--which, as the authors point out, are the best predictors of success as an adult.
    Among other things, the book is testimony to the power of the Internet to organize isolated, information-starved people into a community. The Oasis Web site has had more than a million visits, and much of the good advice in the guide comes from the parents--and adults with Asperger syndrome, who proudly call themselves Aspies--who flock to its message boards to tell their stories about schools, doctors, drugs and encounters with the "neurotypical" world. Ultimately, these stories are not discouraging but reassuring, for they make clear that no Asperger's parent is alone. Every child is different. But every infuriating misdiagnosis, every uncaring (or caring) school official, every setback, every gain finds an echo in the experiences of the hundreds of people whose contributions make this book such a rich and human document. "When the shock wears off, and it will," a parent writes about first receiving the Asperger's diagnosis, "you will realize that this is the same child you have nurtured and loved since birth."

Prechter Family's Foundation Seeks End to Stigma of Depression
Associated Press, 11/13/2001

SOUTHGATE, Mich. -- The family of Heinz C. Prechter hopes a foundation set up in his memory will help others afflicted with the mental illness that ultimately lead the industrialist millionaire to kill himself. Waltraud "Wally" Prechter, chair of Prechter Holdings Inc. and president of the Prechter family's World Heritage Foundation, established the nonprofit Heinz C. Prechter Fund for Manic Depression to generate funds, search for a cure and raise awareness about manic depression. "If we can prevent just one family from going through what we and thousands of other families are going through today, Heinz's tragic passing will not have been in vain," Waltraud Prechter said in a statement.
    In July, the Grosse Ile philanthropist and entrepreneur -- credited with popularizing sunroofs in the United States -- took his own life after battling manic depression for more than three decades. He was 59. At her father's funeral, Prechter's 21-year-old daughter, Stephanie, said she promised to apply the lessons of her father's death. "I will try to be open about depression, the disease that afflicted you and eventually claimed your life," she said. Depression affects one in every five Americans over the course of a lifetime. However, the stigma of mental illness prevents most from seeking treatment. Only about 10 percent of those with depression seek medical treatment. More than 30,000 Americans commit suicide every year.

Most in Poll Favor Prison to Death for Andrea Yates
Lisa Teachey, Houston Chronicle- 11/13/2001

More than half of voters polled recently said they would rather Andrea Pia Yates be sent to prison for life than be sentenced to death if she is convicted of drowning her children. Of the 663 polled, 19.4 percent favored the death penalty for Yates and 57.3 percent said she should receive a life sentence. Almost 8.7 percent said they did not believe in the death penalty; 11.5 said they did not know how they felt about Yates; and 3.1 percent refused to answer the question.
    The Houston Chronicle/KHOU-TV poll, composed mostly of election-related questions for registered voters, had only one question regarding Yates -- whether she should die by lethal injection or face life in prison if she is found guilty. The Harris County jury pool is made up of registered voters and licensed drivers. While one defense lawyer not connected with the Yates case said the poll results should worry prosecutors, a victims' rights advocate said the poll reflects only the opinions some voters have formed from media reports.
    Yates called police to her home in the 900 block of Beachcomber on June 20 and told them she had drowned her children -- Noah, 7; John, 5; Paul, 3; Luke, 2; and Mary, 6 months -- in the family bathtub. Her family said she had been treated off and on for severe depression over a two-year period before the deaths. She has pleaded not guilty by reason of insanity to two charges of capital murder in the deaths of three of her children. Prosecutors are seeking the death penalty. Harris County District Attorney Chuck Rosenthal said the decision was made to give jurors a full range of punishment options. In September, a jury found Yates, 37, was competent to stand trial.
    Pollster Bob Stein, a political science professor at Rice University, said there was no significant statistical difference between men and women questioned for the poll. The poll's margin of error is 4.25 percentage points. Men were only slightly more likely to favor the death penalty for Yates -- 21.3 percent of the men said she should be put to death compared with 17.9 percent of the women. Of the women polled, 57.9 percent chose life in prison compared with 56.3 percent of the men.
    Stein said the results may not show a true picture of the Harris County jury population because registered voters tend to be older and less ethnically and racially diverse than the entire pool. Jury panels typically have more younger people and more minorities; both groups are less likely to support the death penalty. That should cause prosecutors to be concerned, said lawyer Brian Wice, who is not connected with the case. A court-imposed gag order prevents prosecutors, defense lawyers, investigators and witnesses in the case from commenting. "The numbers underscore the fact that the lion's share of people don't think this is an appropriate case for the ultimate punishment," Wice said. "It shows that more people view Andrea Yates as psychologically disturbed rather than hopelessly evil."
    Dianne Clements, president of the Houston victims' rights group Justice For All, said the voter-specific poll didn't give respondents enough information to accurately show how a jury might decide. Clements also said the poll is skewed because of the gag order. Just before the gag order was imposed, Yates' husband, Russell, held a news conference saying he supported his wife and told of her mental illness. "The jury will have all of the information, not just sympathetic quips by her husband and what has been reported by the media," Clements said. "Polling opinions are based on nothing other than assumptions. No facts are involved. Jurors make decisions based on the facts."  While a random telephone poll of Harris County citizens conducted earlier this year for the Chronicle showed 62.2 percent generally favored the death penalty, Stein said that is not necessarily inconsistent with the Yates poll.
    "Everybody supports the death penalty except, of course, when you give the details to mitigate," Stein said. The way the Yates poll question was posed, to include the words "may suffer from a form of depression," may have made respondents more sympathetic. "People who say they favor the death penalty generally think of it for serial killers or a robber who blows away a store clerk," Wice said. "It doesn't mean they think the death penalty is appropriate for every case. ... That's why we have jury selections. That's why we have criminal trials."

Michigan Teenager Who Killed Self at School `Never Popped up on Radar'
Dee-Ann Durbin, Associated Press- 11/13/2001

CARO, Mich. -- A 17-year-old gunman who killed himself after a three-hour hostage standoff in his classroom was a somber, polite student who showed no warning signs of violence, his principal said Tuesday. ''I've had people I've expelled for threatening to kill people. It wasn't one of those who did it. It was a kid who never popped up on my radar,'' said Erl Nordstrom, principal of the Caro Learning Center, an alternative high school for troubled students.
    Chris Buschbacher was upset over a breakup with his girlfriend two days before Monday's standoff, Tuscola County Undersheriff Jim Jashinske said. The teen hid a .22-caliber rifle, a 20-gauge shotgun and a tube of gunpowder in a locker room shower stall sometime Monday. The girl, who wasn't named by police, was in a classroom with a teacher and two other girls when Buschbacher walked in with the guns Monday afternoon, Jashinske said. She and another girl ran to Nordstrom's office, saying Buschbacher was firing a cap gun. Audrea Jackson, 15, and science teacher Joseph Gottler were taken hostage. When Nordstrom entered the classroom, he found Buschbacher seated at Gottler's desk. ''He said, `Erl, get out of here,''' Nordstrom said. The teen then fired a warning shot in Nordstrom's direction, the principal said. Nordstrom, who said he didn't see the hostages, instructed his secretary to call 911, and he evacuated the building room by room.
    Nordstrom returned after the evacuation, but Buschbacher threatened to shoot again. After negotiations with sheriff's Lt. James Giroux, Buschbacher released Jackson in exchange for a pack of cigarettes and a lighter, and freed Gottler about an hour and a half later. Neither was injured. The teen's mother came to the scene, but he refused to speak with her, Jashinske said. Buschbacher shot himself in the head in the classroom while a state police emergency response team was preparing to enter the building. The teen brought the guns from his Caro home where he lived with his mother and stepfather, authorities said. Jashinske said Buschbacher had no criminal record.
    Schools in the town don't have metal detectors, security checkpoints or guards, but 15-year-old Matt Franklin, a sophomore at nearby Caro Community High School, said he wished they did. ''If it happened there, it could happen anywhere,'' he said. About 110 teen-agers with attendance or discipline problems are students at Caro Learning Center, about 75 miles north of Detroit. It was closed Tuesday. Buschbacher had been there for two years because of minor discipline problems, according to the principal. ''He was very low-key. To be honest with you, I don't think I ever saw the kid smile. He was respectful. He always said, `Hi,''' Nordstrom said.

Schizophrenia Linked to Herpes Infection in Mothers
Reuters, 11/13/2001

NEW YORK -- Children born to women who had a herpes simplex virus type 2 (HSV-2) infection while pregnant appear to have a higher risk of developing schizophrenia, researchers have found. Schizophrenia is a severe brain disorder that alters a person's emotions, thought processes and perceptions of reality. Symptoms of the disorder, which affects about 1% of the world's population, typically surface during the late teens and 20s.
    While the causes of the disease are not known, schizophrenia is believed to arise from a mix of genetic and environmental triggers. Some experts speculate that maternal infection during pregnancy is linked to the subsequent development of schizophrenia and other psychoses in adulthood, Dr. Stephen L. Buka from the Harvard School of Public Health in Boston, Massachusetts, and colleagues note in the November issue of the Archives of General Psychiatry.
    To investigate, the researchers analyzed stored blood samples from the mothers of 27 adults with schizophrenia. The blood samples had been collected at the end of each woman's pregnancy. Buka's team compared these samples to blood samples from the mothers of 54 healthy adults. The analysis revealed an association between antibodies for HSV-2 in a mother's blood and a child's subsequent development of schizophrenia. The researchers "did not find significant differences" between the groups when other infections were taken into consideration. "The evidence shows some association of maternal HSV-2 with schizophrenia later in life," co-author Dr. Robert Yolken of the Johns Hopkins Children's Center in Baltimore, Maryland, said in a prepared statement. "However, whether the herpes infection is a direct cause or just a factor is still unknown."
    Herpes is a sexually transmitted disease caused by the herpes simplex virus. Herpes simplex virus type 1 (HSV-1) causes fever blisters on the mouth or face, while HSV-2 affects the genital area. Most of the time, HSV-1 and HSV-2 are inactive, or "silent," and cause no symptoms, but some infected people have periodic outbreaks of blisters and ulcers. Once infected with HSV, people remain infected for life. In the United States, 45 million people aged 12 and older, or one out of five of the total adolescent and adult population, is infected with genital herpes.

Comedian Is Jailed for 3 Hours for Relapse in Treatment
Steve Berry, Los Angeles Times- 11/14/2001

Comedian Paula Poundstone, serving five years' probation for endangering her adopted and foster children, was briefly jailed Tuesday after suffering a relapse during court-ordered drug and alcohol rehabilitation. Poundstone was handcuffed by a bailiff and taken into custody at the direction of Santa Monica Superior Court Judge Bernard J. Kamins following a morning hearing. Hours later, Kamins called the stand-up comedian back into his courtroom, ordered her freed from jail and instructed her to return to a Malibu residential treatment program. She spent about three hours behind bars. "He was trying to get her attention and to encourage her to conform," Deputy Dist. Atty. Gina Satriano said after the court proceedings. She said the relapse was a single incident in which Poundstone took some prohibited "medication." Satriano said the judge did not identify the medication or say how she got it. The prosecutor said Poundstone admitted the violation.
    Poundstone, 41, had three adopted children and two foster children, ages 2 to 12, until they were removed from her home after she was arrested June 27. She pleaded no contest in September to felony child endangerment and a misdemeanor charge of inflicting injury on a child. In exchange for the plea, prosecutors dropped three counts of lewd acts upon a child. The child endangerment charge stemmed from an incident June 6 when she drove the children to get ice cream while she was drunk, her attorney has said. Prosecutors have said the misdemeanor charge involved "inappropriate touching."
    Poundstone's sentence included six months in a drug and alcohol treatment program, which was scheduled to end Dec. 5. She also is required to attend psychiatric counseling, participate in a child abuse prevention program, stay away from alcohol and drugs, complete 200 hours of community service and pay $1,000 in fines. Poundstone has been enrolled in the Promises treatment program in Malibu. Satriano said the treatment center's report to the judge noted that Poundstone had been making progress in her rehabilitation until she took the medication. "The consequences were proportionate" to the violation, Satriano said of the judge's action Tuesday.
    Probation conditions require Poundstone to remain at the treatment center full time. Under the supervision of a Promises staff member, Poundstone had been allowed to leave for brief visits with her children or to her home, but that privilege was rescinded Tuesday, Poundstone spokesman Allan Mayer said. Poundstone was ordered to return to court for another progress report Dec. 5. Kamins said he probably would extend her time in rehabilitation if she has a relapse. Mayer said Poundstone's performances in early December probably will be rescheduled.

Nicotine Numbs Will to Quit in Many Smokers
Rachel Sauer, Cox News Service- 11/14/2001

GRAND JUNCTION, Colo. -- People shouldn't smoke. It's a terrible habit. We all know that. We've seen the posters of ravaged-looking women puffing on cigarettes like junkies. We've seen the tarry black lungs hanging limply like trash bags at American Lung Association health fair booths. As we'll be reminded Thursday during the Great American Smokeout, smoking can be devastating. But quitting, an act that is in the best interest of body and mind, often is thwarted by the body and mind. Why is quitting so hard? The reasons could be as varied as the people smoking, but pulmonologist Garry Lambert said three of the main reasons are nicotine addiction, habit and a need for stress relief.

The problem with nicotine
Physiologically, the nicotine addiction could be the trickiest to beat. "Nicotine is a stimulant," Lambert said. "If the body is on a regular stimulant all the time, when you stop that rush of stimulation is shut off." Nicotine, which is a natural part of tobacco, is not the dangerous part of cigarettes. That would be the more than 60 cancer-causing agents. Nicotine is the addictive part. When it's smoked, it enters the bloodstream through the lungs and reaches the brain in about 8 seconds.
    When it reaches the brain, nicotine mimics a neurotransmitter called acetylcholine, which not only is involved in movement, breathing, heart rate, learning and memory but also causes the release of neurotransmitters and hormones that affect mood, appetite and memory. Nicotine activates the areas of the brain involved in producing feelings of pleasure and reward. Specifically, it raises the levels of dopamine, a molecule that produces feelings of pleasure. Increased dopamine levels are involved in heroin and cocaine addiction, and researchers now believe in nicotine addiction.
    It has the ability to calm people down, reduce awareness of pain, consolidate learned material into long-term memory and maintain alertness for boring, repetitive tasks, said Betty Mason, program coordinator for the Mesa County Tobacco Education Council. Cigarettes, she said, can give people a sense of control over feeling good. The average smoker self-administers 200 to 300 nicotine hits per day, Mason said. "Kids don't realize when they start smoking that this is going to happen to them. They don't realize they are dosing themselves," she said. "They just think they are smoking cigarettes, but they don't realize they are giving themselves little hits of tranquilizers."
    Researchers have found that nicotine can disrupt normal brain function. Users must regularly supply the brain with nicotine to maintain normal brain function, according to the National Institute on Drug Abuse.  So when a person quits smoking, the brain and subsequently the body are thrown into upheaval. The brain is used to functioning with the nicotine and making the body feel good from it, so it wants the nicotine. That unfulfilled want, called withdrawal, can cause nausea, jitters, irritability, sleeplessness, an inability to concentrate and intense cravings for cigarettes. It can be one of the strongest, most painful, gnawing physical wants a person ever will know.

More than physical
Psychologically, the habit of smoking might be harder to break. People smoke at certain times of the day, during certain activities, as a reaction to certain stimuli. Not responding to those situations by smoking, particularly after years of the habit, can make a person feel uprooted, at loose ends and unable to figure out what to do with their hands and mouth. Many smokers also cite smoking a cigarette as a way to relieve stress, so quitting can cause anxiousness from physical withdrawal coupled with anxiousness over not being able to cope with life stress. That combination may send many people willing to quit back to cigarettes.
    The average smoker tries quitting several times before succeeding, Mason said, and people shouldn't feel guilty if they don't make it the first, second or even third time. The body and mind are making it hard for them. What people should do, Mason and Lambert said, is get help. Going cold turkey off cigarettes rarely works. Consulting a physician or a smoking-cessation therapist can help people identify the cues that prompt them to light up, determine the emotional reward cigarettes give them and try to find replacement rewards, find a friend or quit-smoking partner to call when they want a cigarette and identify whether medication, nicotine patches or nicotine gum would help.
    The American Lung Association also offers resources for people who are interested in or are ready to quit smoking at www.lungusa.org/tobacco

New Study Suggests Dyslexia May Afflict More Boys Than Girls
Melinda T. Willis, ABC News- 11/14/2001

Most people are very careful to avoid preferential treatment for students based on gender, but new research suggests boys may need special attention to cope with a higher prevalence of reading disabilities. The findings, which appear in today's issue of the Mayo Clinic Proceedings, are part of a large study that examined the reading skills of 5,718 children born in Rochester, Minn., between 1976 and 1982 who remained in the area after the age of 5.
    The researchers found that boys were two to three times more likely to suffer from dyslexia than girls. Dyslexia is a learning disorder in which an individual has difficulty reading despite having had adequate access to education and sufficient intelligence. Overall incidence of reading disability varied between 5 percent and 12 percent in the study population, suggesting that dyslexia is common in children. Results of a previous study conducted in Connecticut had established that there were no such gender differences in incidence of dyslexia. "There are over 20 million children in the United States between the ages of 5 and 9 and as many as 1 to 2.4 million of them could have dyslexia," says Dr. Slavica Katusic, an epidemiologist at the Mayo Clinic and lead author of today's study.
    While all of the contributing factors of dyslexia are unknown, there is strong scientific evidence to suggest that it is genetic in origin. "There is a difference, literally, in the brain architecture that causes a certain part of the brain of a person with dyslexia to have trouble decoding the written word," says J. Thomas Viall, executive director for the Baltimore, Md.-based International Dyslexia Association.
    According to Katusic, previous studies show that male and female brains process reading differently and that these differences may account for the results of the current study. Katusic plans further research to determine what accounts for these differences. For example, are there risk factors during pregnancy, delivery or after delivery that may contribute to the risk of developing dyslexia.
    While there is no cure for dyslexia, children with dyslexia can improve their language abilities by learning special skills. Recognizing dyslexia and teaching these skills, however, requires committed teachers, parents and school systems. "Some school districts won't even acknowledge that dyslexia exists," adds Viall. "The public school system in America is poorly equipped to deal with it." According to Katusic, the findings of today's study have many implications for those who are involved in aiding children, even those who work outside of the educational system. "Physicians can ask about a child's progress with reading, teachers can determine if a problem child is actually a child with a reading problem, and parents can explore whether reading is the main problem their child is having in school," adds Katusic.

40% Tell of Stress Following Terrorist Attacks
Charles Ornstein, Los Angeles Times- 11/15/2001

More than 4 in 10 adults suffered serious stress reactions in the days immediately following the Sept. 11 terrorist attacks, according to a new survey by the Rand Corp. to be published today in the New England Journal of Medicine. The survey, among the first to quantify the emotional toll of the attacks, confirms anecdotal stories of grief that have been reported around the country, said lead author Mark A. Schuster, a Rand Corp. researcher and UCLA pediatrician. Rand is a Santa Monica-based research group.
    The report also highlights the need for a quick response by counselors, teachers and clergy to help people deal with disasters, even for people far from the attack sites in New York City and Arlington, Va. The survey of 560 adults, conducted Sept. 14 to 16, found that 44% experienced at least one significant stress reaction after Sept. 11. These reactions included having difficulty concentrating, feeling very upset, feeling irritable, having trouble sleeping or having disturbing memories or dreams. Nine in 10 people reported at least low levels of those stress reactions.
    Those disproportionately affected included women, minorities, people with previous emotional problems and people who watched extensive television coverage on Sept. 11. The study also found that 35% of children older than 5 had problems and 47% worried about their safety, according to their parents. "It's important for people to know that they're not the only ones, that this is occurring all over the country and that there are a lot of people experiencing this," Schuster said. "It's not pleasant to have these symptoms, but people are quite resilient."
    In the days following the attacks, crisis counselors nationwide reported a surge in requests for stress debriefings for employees. These meetings allowed workers to discuss how the attacks affected them and to ask questions about how to explain the events to children. But, counselors say, the events since Sept. 11 have made it difficult to reestablish a routine. "About the time you start to emotionally settle from the tragedy itself, then the anthrax thing raises its head. And then the airplane crashes," said Robert T. Dorris Jr., president of Robert T. Dorris & Associates, an employee assistance firm in Agoura Hills. "Every human being has a reserve of coping mechanisms, and when you keep them in overload long enough and there's so many unknowns, people stay in a high anxiety state."
    People responded to stress in different ways, the survey found. Nearly everyone--98%--talked with others about their thoughts and feelings. Nine in 10 turned to religion and 60% participated in group activities, such as discussions and vigils. Three-quarters checked the safety of immediate family members or friends; 36% donated blood or money or volunteered; and 18% procured extra food, gas, cash or other supplies.
    Few scientifically valid studies have been conducted in the days following disasters, Schuster said. After the Oklahoma City bombing, for instance, researchers surveyed people one to two months later and asked them to recall how they felt right after the event. "People's memories change," Schuster said. "What they said they felt is very often quite different from what they did feel. . . . You don't want to walk around remembering that during the few days after the attacks, you were snapping at people and not getting your work done."

Longtime Addicts Test Califormia's Proposition 36 Drug Treatment
Jenifer Warren, Los Angeles Times- 11/15/2001

SACRAMENTO -- Four months into California's landmark experiment with treating drug offenders as patients rather than criminals, officials are scrambling to cope with a clientele that is far more severely addicted than expected. Planners predicted that most offenders diverted into treatment under voter-approved Proposition 36 would be low-level users in need of short-term outpatient therapy. Instead, judges and others with a role in the new system say it is beset by hard-core addicts, many of whom have multiple convictions and need help with mental health problems as well. "These are clients who need intensive, highly structured residential treatment for a substantial period of time," said Santa Clara County Superior Court Judge Stephen V. Manley. "We simply don't have beds for them, and that's a very serious long-term problem for the state."
    Manley was among two dozen witnesses at a legislative hearing Wednesday that offered the first broad assessment of Proposition 36, which triggered the most dramatic shift in criminal justice policy since passage of the three-strikes law. Approved by voters a year ago, Proposition 36 requires that nonviolent drug offenders be placed in treatment and on probation, rather than behind bars. Backers of the groundbreaking initiative hope to place similar measures on the ballot next year in several states, so its record in California is being closely watched. Legislators also want to know whether the state's $120-million annual investment in drug treatment is paying off.
    Wednesday's hearing provided no final answer to whether Proposition 36 is delivering on its ambitious promise--to reduce addiction, thin the prison population and save the state money. The first offenders only began landing in treatment in July, so it is too early for a sweeping verdict. But experts--and recovering addicts--said the system, though still plagued by kinks, is funneling thousands of addicts into recovery. "It has absolutely been an early success," said Chris Geiger of Walden House in San Francisco, a residential recovery program. "It's helping me change myself into a productive person," said Jacquelyn Jones, 40, a 22-year crack addict living at Walden House. "Jail and prison only put your addiction at rest until you are released."
    Though no statewide statistics are available, officials in most counties said their projections for the number of offenders receiving treatment through Proposition 36 are proving fairly accurate. The exception is Los Angeles, where the number of defendants opting for treatment is far lower than expected. Most surprising is the proportion of offenders with a long history of drug abuse. Manley said that in Santa Clara and San Diego counties, about half of the clients have addictions spanning 10 years or more. Judges in Los Angeles report similar trends.
    Under Proposition 36, offenders who go into treatment are sent to an assessment center, where officials gauge the severity of their drug problems and, in theory, assign them to appropriate treatment slots. Therein lies the problem. In gearing up for the influx of Proposition 36 cases, county officials focused on creating outpatient slots suitable for low-level addicts. As a result, the wait for a spot in a Los Angeles-area residential treatment program can be four to eight weeks or more, said Los Angeles Superior Court Judge Michael Tynan. "So we have many of our most severely addicted people sitting on waiting lists, and that doesn't help anybody," said Lael Rubin, special counsel to Los Angeles County District Attorney Steve Cooley.
    How government will expand residential treatment capacity is unclear. The state faces a budget crisis, and, as Tynan said, residential beds are "expensive, and you just can't create them overnight." Even when funding is available, drug treatment homes invariably stir neighborhood opposition, witnesses said Wednesday. "We consistently see 300, 400, 500 people at every hearing," Yvonne Frazier, administrator of San Mateo County's alcohol and drug programs, testified. "And there are usually about two speaking in favor."
    Among the few pieces of concrete information emerging at the hearing was evidence that Proposition 36 is causing a dip in the state prison population. From July 1 through Nov. 4, the incarcerated population fell by 2,400 inmates, a drop that corrections officials attribute mostly, though not entirely, to Proposition 36. Considering that the state spends $25,000 annually on each prisoner, "we are already starting to achieve some savings because of Proposition 36," said Dan Carson of the nonpartisan Legislative Analyst's Office.
    Another measure of the program came from the state parole board. Before Proposition 36, parolees who violated terms of their parole with low-level drug offenses, such as dirty drug tests, were often returned to prison. Now, 140 parolees a week are diverted into drug treatment, and officials said most comply with such orders. Since July 1, only 31 warrants have been issued for parolees who did not follow through.

'Less-Costly' Drug Plans Will Actually Cost More
Lee Bowman, Scripps Howard News Service- 11/15/2001

If you haven't felt the pinch already, get prepared for sticker shock at the drug counter as more health plans adopt a three-tier pharmacy benefit to push consumers to less costly drugs, a new study warns. Under most three-level plans, consumers typically pay the least out-of-pocket for generic drugs, more for brand-name drugs from a preferred list and the highest share for name-brand drugs not on a preferred list. "The three-tier design gives consumers a financial stake in deciding whether the non-preferred drug is worth the additional cost, rather than the health plan denying coverage altogether," said Paul Ginsburg, president of the Center for Studying Health System Change, a non-partisan research organization that conducted the study, released yesterday.  A recent survey by the William Mercer consulting firm reported that 91 percent of all employer-sponsored health plans require a drug co-pay; while another survey by the consultant Scott-Levin found that 80 percent of plans offer three-step payments for drug coverage.
    The move to the new drug benefit systems appears to have helped slow the growth of drug spending by health insurers, at least for the short-term, but questions are already being raised about the cost and quality of pharmaceutical care for consumers, according to the study, which was based on interviews with health-plan executives in 12 communities around the country. Since 1990, prescription-drug spending has more than doubled, far surpassing the rate of growth for other types of health care. That has pushed health insurers to impose restrictions to control costs, even though such drugs account for only about 15 percent of all health spending. Until a few years ago, many HMOs had tried to directly limit which drugs they would cover to a specific list, but most gave up because there were so many complaints from doctors and patients.
    The study notes that health plans are again considering putting more drugs on exclusion lists, especially those that aren't deemed cost-effective or medically necessary when other cheaper drugs are available. In most health plans, administrators have tried to offer consumers free choice on drugs, but increasingly at steeper price for the more costly pharmaceuticals, which are usually the newest and most heavily advertised products. For instance, Blue Cross members in Boston, depending on their plan, pay $5 or $10 for generic drugs; $10 to $20 for preferred brand-name drugs and $25 to $35 for non-preferred brand names. Plans in some markets, however, have bumped cost-sharing even higher by replacing fixed co-pay amounts with coinsurance rates tied to the price of the drug, such as a 10 percent-20 percent-30 percent design being used by some plans in Seattle and in Orange County, Calif.

Defense Begins Laying Out Insanity Case in Murder Trial
Associated Press, 11/15/2001

LAWRENCE, Mass. -- A cross-dressing dermatologist charged with shooting his wife to death with a hunting rifle told jurors Thursday that he began wearing women's clothing at a young age as an escape from an abusive father. Dr. Richard Sharpe, who grew up in Shelton, Conn., said his father called him ''every permutation and combination of profanities you could imagine, every day,'' when he took the stand in his own defense. He described his 27-year marriage to Karen Sharpe as a steady stream of fights and infidelities, though until last year the couple always made up.
    Sharpe's lawyer said Sharpe grew up with a variety of mental disorders as a result of his father's abuse, and that he was insane the day he gunned down his estranged wife in her Wenham home. Prosecutors maintain Sharpe was eccentric but sane. They say he killed Karen because he was angry about the possibility of losing millions of dollars in their divorce.  Sharpe, charged with first-degree murder, spoke quietly with his eyes mostly closed and his hand often covering his face. He broke down intermittently, first when he was asked to describe when he first met Karen in high school.
    Sharpe said he began wearing women's clothes as an adolescent because of constant verbal abuse. The cross-dressing became so frequent that he bought his own clothes; he said his father became angry because he thought Sharpe had taken his sister's clothes. Sharpe described a childhood in which he was regularly picked on by bigger boys. ''I invariably got beat up on a regular basis, to the point where it was almost a joke,'' he said. He said he met Karen Sharpe after noticing her in the hallway at their high school. Shortly after they began dating, she became pregnant, and they married.
    There were problems from the start. Sharpe said his wife left a half dozen times in the first five years of their marriage during the 1970s, but returned each time. Several of her disappearances caused him to ''freak out,'' he said, and he recounted slapping his wife after confronting her about an alleged affair. During the 1990s, the couples finances improved and so, at times, did the marriage. Sharpe's medical practice and laser hair-removal business built the family's net worth to more than $5 million. But Karen left again in February, 2000, and the marriage disintegrated. In one argument, Richard Sharpe recalled ''accusing her of using me as a meal ticket.'' ''Whenever we got some money, it seemed like something bad happened,'' Sharpe said. ''My happiest memories were from the times we'd sit down on a Saturday or Sunday, and count the change, maybe go the movies or something.''
    Sharpe was expected back on the stand Friday. Earlier Thursday, Sharpe's brothers, Robert and Ben, and a childhood friend, Frank Pelaggi, testified they'd seen Richard Sharpe's father be verbally abusive to him while he was growing up in Shelton. ''I saw him call him names, call him stupid,'' said Robert Sharpe, 63, who now lives near Milford, Conn. ''He wanted to make us feel like we were low, worthless. He did it to me, he did it to my brother.''  Robert Sharpe also said his now-deceased father physically assaulted him in front of Richard. On cross-examination, witnesses testified Sharpe's outbursts were short-lived. And one brother testified he spoke to Sharpe on the day of the murder, and he sounded normal.

U-M Coordinates Its Study and Treatment of Depression Cases
David Wahlberg, Ann Arbor News- 11/15/2001

Lab research, human studies and patient treatments for depression will be under one organization - and, most likely, eventually under one new roof - if the University of Michigan Board of Regents today approves a "comprehensive depression center." What U-M is billing as the nation's first coordinated effort to quickly apply lab findings about depression to the clinic and discoveries about patient needs to lab studies will involve about 100 U-M researchers from a variety of disciplines, said John Greden, head of psychiatry at the university and executive director of the proposed center.
    About 18 million Americans suffer from depression, a disease the World Health Organization has ranked as the fourth most disabling globally. Most people with depression initially see primary care doctors, who often are too rushed or unaware of the disease to detect it, allowing symptoms to get worse as they remain untreated, Greden said. The center aims to improve that with better screening and patient follow-up, and by applying research results swiftly. Studies show that some patients do better with behavioral therapy than with medications. "Only about 10 percent of people with depression receive the recommended approach today," Greden said. "That's pretty uncomfortable, and we're trying to change it."
    The center will be a virtual one at first, pulling together faculty from psychiatry, family medicine, pharmacy, public health, nursing, the Institute for Social Research and other areas and allowing them to expand their efforts by applying for more grants. For example, depression screening that started two years ago in pregnant women has spread to pediatrics, family medicine and breast cancer clinics and soon will begin in cardiology.
    Fund-raising is under way for a planned $32 million depression center that may be built next to U-M's East Ann Arbor Health Center on Plymouth Road by early 2004, Greden said. U-M is trying to raise $12 million toward what it envisioned as a 100,000-square-foot building, he said. The building likely would replace the Riverview Building on Wall Street that now houses most U-M psychiatry services. Plans for the depression center building will go before the regents for approval in a few months.
    Merrie Blunk, 36, of Saline, who had postpartum depression following the birth of her first son nine years ago, welcomes U-M's new approach to study and treat the disease. An educational psychologist who lectures at the university, Blunk had trouble sleeping and eating after the birth. She obsessed about odd things, wondering if she had to get a car for her son when he turned 16, feeling distraught when people on TV commercials had to choose among breakfast cereals. "I would sit there and think, 'How do they know which brand to select?' I was used to being a very reasonable and rational person, and I couldn't cope with myself," she said. Her primary care doctor thought the problem stemmed from low blood sugar levels, she said. It wasn't until she saw a U-M psychiatrist that she was diagnosed with postpartum depression, which can occur from altered hormones during pregnancy and birth. Blunk went on the medication Prozac and soon felt better. When she had another child five years later, the experience was much better. "It was a huge relief," she said. "More doctors need to know what to be looking for."

D.C. Studies Taking Away Drug Babies
Scott Higham and Sari Horwitz, Washington Post- 11/16/2001

Babies born with drugs or alcohol in their blood would automatically be taken from their mothers' custody under legislation before the D.C. Council, part of wide-ranging revisions proposed for the city's child protection system. The proposal, unveiled yesterday, is dividing the child protection community between those who believe babies should be safeguarded at all costs and those who call the measure Draconian and say it would result in more infants being exposed to drugs and alcohol. They argue that mothers may avoid prenatal care out of fear they would lose their children.
    Under the measure, sponsored by council member Sandy Allen (D-Ward 8), children born exposed to drugs or alcohol would be "presumed" neglected or abused. It would require the D.C. Child and Family Services Agency to "begin immediate proceedings to remove the child from the home of the mother" and would order social workers to open investigations. "My concern is this: Without this legislation, what will the District of Columbia do?" Allen said. If social workers determine that the mothers cannot care for their babies, the city would provide a variety of social services -- including financial aid and drug treatment -- in an effort to reunite the family. If those services failed, the babies would remain in foster care.
    The D.C. Council has been considering a change in the law that would require city social workers to open abuse and neglect investigations when babies are born exposed to drugs. But the new proposal goes further. If approved, it would be among the toughest provisions of its kind in the nation. Only five states have passed similar laws. City officials said yesterday that something should be done. But several officials testified that the proposal could deter mothers from seeking prenatal care and drug treatment and put more babies into an already strained foster care system.
    Deputy Mayor Carolyn N. Graham said the city estimates that 1,500 -- or 20 percent -- of the 7,500 women who give birth in the District each year use drugs or alcohol during their pregnancies. Rather than remove those babies from their mothers, she said, the city should try to provide mothers with drug rehabilitation and monitoring to make sure the infants are safe. Graham and Child and Family Services chief Olivia A. Golden said they are working with the city's health department to draft a "memorandum of understanding" that would outline steps to be taken when a drug- or alcohol-exposed baby is born and how the city would assist the mother and her child. They, along with health Director Ivan C.A. Walks, said the city could protect children and turn the lives of mothers around without breaking up families.
    But Allen questioned whether such a memorandum would be sufficient. "When this administration goes away, the [memorandum of understanding] will wind up in a desk drawer," she said. Others expressed deep reservations about Allen's proposal. "It goes too far," said Elizabeth Siegel, a member of the Child Fatality Review Committee, which reviews deaths of D.C. children.
    Wyndi Anderson, an organizer for the National Advocates for Pregnant Women, testified that the proposal unfairly targets poor, minority women. She argued that pregnant women would avoid seeing doctors. "I cannot, in good faith, stand by and not speak out when policies will serve only to target and punish the poor addict and the addict of color, offering no real solutions," Anderson said.
    A recent Washington Post investigation found that from 1993 to 2000, 40 children died after government workers failed to take preventive actions or placed the children in unsafe homes or institutions. Eleven of those children were drug-exposed infants who died after being sent home to parents whose troubles were known by hospitals and social workers.

High Costs Hinder Effectiveness of Smoking Treatment Programs
Garret Condon, Hartford Courant- 11/16/2001

Every year, it snuffs out half a million American lives. Now, there is an effective treatment for smoking that can save thousands from death and disability. But that treatment--though endorsed by a federal health panel--is not available to many who need it most. "It's almost an embarrassment that we can't afford to give people treatment for something that's killing them and causing all kinds of negative outcomes and costing money in the long run," said Dr. Michael Goldstein, associate director of the Bayer Institute for Health Care Communication in West Haven, Conn. Goldstein, who is also an adjunct professor of psychiatry and human behavior at Brown University in Providence, R.I., and a psychiatrist at Miriam Hospital in Providence, was a member of the panel that created the new guidelines for helping smokers quit.
    The guidelines were issued by the U.S. Public Health Service to encourage physicians to help patients get off tobacco. About a fourth of the adult population smokes, and 70% of these smokers report that they want to quit. The treatment includes a combination of brief counseling, social support and the use of drugs, such as nicotine replacement products (gum, inhaler, patch or spray) and Zyban (Buproprion SR), which suppresses the urge to smoke. Tobacco-dependence researchers have found that the drug-and-counseling combo is more effective than either approach alone, better than quitting classes and four times more successful than the unassisted "cold turkey" method.
    But not if you can't afford the treatments. Smokers tend to have lower income than non-smokers. The most recent federal data, from 1999, show that smokers make up a third of those below the poverty line. And cessation drugs are costly. One of the cheapest, Zyban, costs more than $100 for seven weeks of a regimen that normally runs between seven and 12 weeks. The 12-week Nicorette nicotine gum program runs about $200.
    Of course, these costs pale next to the price tag on a lifetime Marlboro Lights habit. A pack goes for between $3 and $4, which means that a pack-a-day habit can cost more than $1,400 a year--not to mention the costs of its health consequences. But, as frustrated quitter Louann Frost of Manchester, Conn., points out, she buys her Marlboros pack by pack, so they don't cripple her cash flow. By contrast, smoking-cessation drugs must be paid for in quantity. And, as Frost knows all too well, smokers frequently repeat the whole program several times before permanently joining the ranks of non-smokers. "Cost is an issue at times," she says.
    It's an issue for many who sign up for the seven-week quitting course offered by the American Lung Association of Connecticut, according to Kim Winter, manager of tobacco programs. The seven-week course costs about $100, or about half the cost of a regimen of nicotine patches, she said. The majority of employer-paid health plans nationwide cover cigarette-quitting drugs, according to the American Association of Health Plans, a Washington, D.C.-based trade group. However, coverage is spotty among insurers. Smokers without health insurance often must pay out-of-pocket for smoking cessation. Medicaid programs in more than half the states cover smoking cessation.

Placebo Antagonists Draw a Dose of Anger
Discover News Service, 11/16/2001

Taking a swipe at conventional wisdom, medical philosophers Asbjorn Hrobjartsson and Peter Gotzsche of the University of Copenhagen recently proclaimed the placebo effect--one of the best-known but least understood curative processes--a myth. After analyzing 114 placebo-controlled trials, they concluded that placebos are generally no more effective at relieving disease symptoms than no treatment at all.
    Now the attackers are under fire from placebo researchers who say the public is being misled. "That article was a travesty," said neurobiologist Howard Fields of the University of California at San Francisco, who in the 1970s demonstrated that placebos appear to relieve pain by inducing the body to release opiates.
    A new study co-authored by neuroscientist Fabrizio Benedetti of the University of Turin Medical School in Italy bolsters this notion. Benedetti found that patients who were informed they were receiving an intravenous analgesic experienced more pain relief than those who received it automatically via an infusion machine. The painkiller's action was enhanced by the knowledge that it was being given, a clear placebo effect. In a little-publicized portion of their paper, even Hrobjartsson and Gotzsche concede that placebos can relieve pain.
    Fields is especially irate that Hrobjartsson and Gotzsche lumped together disparate trials, some of which found a placebo effect, some of which did not. In effect, the trials canceled each other out. Why, then, have reporters rushed to embrace their results? Benedetti blames a reluctance to accept the power of the mind. "It is a sort of sigh of relief: `Aah, we knew medicines were real and not the result of some psychological stuff.'"

Doctor Who Killed Wife Recounts Events Leading up to Shooting
Theo Emery, Associated Press-11/16/2001

LAWRENCE, Mass. -- A wealthy cross-dressing dermatologist accused of killing his wife testified Friday that he had a fragile grip on reality because of money woes, an impending divorce and his estranged wife's financial and amorous affairs. On the fifth day of his trial, Richard Sharpe, 46, gave more testimony on the circumstances leading up to July 14, 2000, the night he shot and killed Karen Sharpe in her home north of Boston as their children watched. Sharpe claims he was temporarily insane due to medications and depression.
    Sharpe testified he went to his wife's home just to talk, though he brought a stolen rifle to the door. He said he'd been drinking and was on antibiotics and antidepressants. He said he noticed her holding a piece of paper, and heard her saying she would call police. The next thing Sharpe said he remembered was ''the gun going off.'' ''Why do you believe the gun went off?'' defense attorney Juliane Balliro asked him. ''Maybe I thought the paper was a restraining order,'' Sharpe said.
    Sharpe, who was on the Harvard Medical School faculty, lost his medical license after his arrest. He parlayed his earnings from his medical businesses into millions in the stock market. Prosecutors say Sharpe killed his wife because he was angry about the possibility of losing his fortune in their divorce. He pleaded innocent to murder, and his attorneys are arguing he was temporarily insane at the time of the shootings.
    During cross-examination, prosecutor Robert Weiner said Sharpe had the same mental and financial troubles at the time of the slaying as he had weeks earlier when he saw his wife with her boyfriend at her home. At that time, Sharpe merely broke the headlights on the boyfriend's truck, Weiner said. Weiner challenged Sharpe's contention that he picked up the gun spontaneously and had no intention of shooting his wife the night of the slaying. He pointed out Sharpe had shut off his car headlights at the end of the driveway before approaching the house. ''Then you walked up this driveway, more than the length of a football field,'' Weiner said. ''For that entire 338 feet from the door of the car to the door of a home, you had a gun with you.'' ''I don't know what the hell was going through my mind,'' Sharpe replied. ''I really don't know.''
    Sharpe said he was devastated when his marriage began to fall apart in February 2000. He said he believed the marriage could be saved after a reconciliation a few months later. Sharpe said he moved into his wife's home in April 2000 and set up a bank account with spending money for her. Soon after, she filed for divorce and sought a restraining order. ''I was a wreck,'' Sharpe said. ''I couldn't deal with it. I couldn't sleep. I couldn't eat. I was crying all the time. I couldn't see patients.'' Sharpe testified he discovered his wife had siphoned off about $78,000 from his medical business without his knowledge. At a court hearing shortly before the slaying, he said his wife's attorney called him a transvestite freak and said he shouldn't have had children. Sharpe said that day he lost whatever grip on reality he had had.
    On the night he shot his wife, he testified, the noise from the gun jolted him back to reality, and he fled to New Hampshire, where he bought a six-pack of beer and a rope, intending to hang himself. Instead, he fell asleep at a hotel and didn't wake up until police arrested him. Sharpe testified further about his cross-dressing, which was revealed before the trial in widely circulated photographs. He said he started cross-dressing as a teen-ager to feel safe from his abusive father.

Michigan School to Test for Drug Use
Peri Stone-Palmquist, Ann Arbor News- 11/16/2001

Donny Skidmore arrived at the hospital blue, with no shoes on. His friends brought him there - the same friends he partied with the night before. Donny's father, Donald Skidmore, got the call at 10 a.m. Aug. 31. His 18-year-old son, a Clinton, Michigan High School dropout, was dead from an apparent drug overdose. Just two months earlier, Donny told his father he would straighten out. He took a job digging graves - and in the end, dug his own.
    It's not news one would expect out of the Clinton area, a rural community straddling Washtenaw and Lenawee counties. And it's not the kind of issue one would expect Clinton Community Schools, one of the smallest districts in the region, to face head on. Yet in the shadow of Donny's death, the school board approved a rare but increasingly popular drug-testing policy that Michigan drug czar Craig Yaldoo said puts the district at the cutting edge of drug prevention.
    Under the new policy, middle school and high school teachers who suspect a student is using can file a report with the principal, who decides whether to administer a $20 oral drug test. In the presence of a third party, the principal conducts the test at school, typically after calling a parent, and has results back within 15 minutes. An outside laboratory retests positive results before disciplinary action is taken. A student is suspended three days for a first offense. A student's refusal to take the test is considered an admission of guilt.
    Only a handful of schools across the state -- none in this region -- have enacted similar policies. Instead, schools rely on students' confessions in a meeting with the principal or more subjective means, such as whether a student smells like marijuana, as the basis for suspension. Several schools, including Ypsilanti and Milan, provide for opportunities to participate in voluntary substance testing off site.
    Clinton's policy was in the works for three years, but losing a former student brought a sense of urgency to the district's mission, High School Principal James DuVall said. Donny's death affirmed the need to be proactive, he said. "It's time to stop this," he said. DuVall said he considers drug use a "small problem" in the district with fewer than two incidents per year on average in the past four years. Still, the district sought additional ways to protect nonusers from users. DuVall said he believes the test will serve as a deterrent, dissuading students from bringing drugs to school or using during the week. School staff must rely on physical clues - bloodshot or glazed eyes, diluted pupils, slurred speech, impaired motor skills or unusual behavior - to report a student. The school has owned a Breathalyzer for years, but it didn't have a foolproof way to test for drugs, DuVall said. "This takes the question out of it," he said.
    But Michael J. Steinberg, legal director for the Michigan chapter of the American Civil Liberties Union, said he questions the accuracy of a test using saliva and not urine. He said such tests are flawed and could result in a student being falsely accused. Matt Andrie, director of marketing for the company making Clinton's drug test, said Avitar Inc.'s ORALscreen is highly accurate and permits fewer chances for tampering than a urine test. Steinberg also said he was concerned the system could be abused, but DuVall said the school would not allow random testing. He said he's worked with school attorneys extensively and believes the district has a strong, legal grounding. Yaldoo, director of Michigan's office of drug control policy, also said the testing plan is legally sound since the school is testing only suspicious students.
    Since Oct. 18, DuVall has received two reports from teachers suspecting students of drug use. One admitted using marijuana and no test was administered. A second student denied the accusation and took the test. "He was a little nervous so there was no saliva at first," DuVall said. After giving the student a glass of water, DuVall placed the thermometer-like foam collector in the student's mouth. About two minutes later, he pushed a clear hood against the foam to squeeze the saliva onto the sample well. After 15 minutes, red lines appeared for marijuana, cocaine, opiates and methamphetamine, meaning the student was clean. It was a relief for everyone, DuVall said. The school doesn't want to see anyone else end up like Donny.
    Last week, Donald Skidmore tried to drive that message home, telling several teens his son's story and urging them to take a different path. "Donny was a good kid," Donald said, recalling his son's love of baseball, golf, fishing, church. "But he's gone because of drugs. ... It could happen just as easily to you." Donny started skipping school more than a year ago, Donald said. By Thanksgiving, he dropped out, and without a diploma, struggled to find good-paying work. In June, he hit rock bottom, Donald said. With no job or money, Donny called his father and promised to straighten out and earn a GED. On the last night of his life, Donny helped his sister, Heather, 14, with her homework and stood out on the deck with his dad, assuring him that everything was OK, that he'd be fine. He was wrong. A toxicology analysis showed traces of four drugs in Donny's system: Valium, an opiate, an anti-depressant and an anti-seizure medicine, none prescribed for medical reasons. "It's not a good way to go," Donald Skidmore told the teens. "I want you to just say no. Be straight. We're not here to get you in trouble. We just don't want to see anyone else die."

N.J. Man Who Let Drunken Friend Drive Faces Prosecution
John Curran, Associated Press- 11/16/2001

SALEM, N.J. -- A judge cleared the way Friday for the manslaughter trial of a man who picked up his drunken friend from police, took him back to his truck and learned later that his friend had been in a deadly car accident.  Superior Court Judge William Forester rejected a motion to dismiss the charges against Kenneth Powell and ruled that a jury must decide whether he committed a crime.
    Powell, 40, was called by police in July 2000 to collect Michael Pangle, 37, at the Bridgeton barracks. Three hours earlier, Pangle had registered a 0.21 blood-alcohol concentration and was charged with drunken driving. Less than an hour after he was released, prosecutors say, Pangle slammed his sport utility vehicle into a car driven by 22-year-old Navy Ensign John R. Elliott. Both men were killed.  Powell, who was not in Pangle's vehicle, was charged with manslaughter, vehicular homicide and aggravated assault by auto and faces up to 15 years in prison. Powell's lawyer, Carl Roeder, had argued that Powell didn't know Pangle was drunk and state police hadn't told him his friend's blood-alcohol level. To hold Powell accountable would open the door to the prosecution of toll collectors, gas station attendants and anyone else who sees a drunken driver but doesn't prevent them from driving, Roeder said.
    Prosecutor Michael Ostrowski argued it was impossible not to know Pangle was drunk, saying his speech was slurred and he could barely stand up. Returning Pangle to his vehicle, when police had told Powell to take him home, was the equivalent of putting a gun in the hand of someone engaged in a heated argument, Ostrowski said.   ''He was an accomplice to a crime that night,'' Ostrowski said. Powell, who is free on bail, declined to comment. A trial date has not been set.

Rhode Island Mental Health Worker Injured in Assault by Client
Associated Press, 11/17/2001

BRISTOL, R.I. -- An East Bay Mental Health Center case manager said he was seriously injured when a client assaulted him. The client, Richard Marshall Jr., 41, of Warren, did not like his counselor taking notes as the two men talked during a visit Nov. 8 at Marshall's mother's house in Bristol, according to police Lt. Michael Serbst.
    Marshall allegedly pushed the counselor, Louis A. Ciaramello, to the floor and stepped on his groin area, Serbst said. Unable to walk and barely able to move, Ciaramello, 51, of Warwick, said he dragged himself to an apartment above the garage to seek help, The Providence Journal reported. No one answered the door. Ciaramello said he entered the apartment and tried to use the phone, which was not working.  Ciaramello, who has worked at Barrington's East Bay Mental Health Center as a substance-abuse counselor for seven years, said he staggered to the driveway, fell to the ground and began yelling for help. Marshall's uncle, who lives next door, heard the screams and contacted the police, Serbst said. Ciaramello was transported to Rhode Island Hospital and released early the next morning, he said. After a police investigation, a warrant for misdemeanor assault was issued for Marshall. He turned himself in last Wednesday, Serbst said. Marshall was arraigned and released on personal recognizance and is scheduled to appear in District Court in Providence later this month. 
    The incident in Bristol occurred one day before Glen S. Hayes, a 39-year-old mobile technician at Mental Health Services of Cranston, Johnston and Northwest Rhode Island, was fatally stabbed while visiting Anthony A. Tavares in his Cranston apartment.

ADHD Answers Too Easy for Some Doctors, Patients
Monte Whaley, Denver Post- 11/18/2001

Even when his teacher nicknamed him "Hopeless," Marcus Loseke didn't want to swallow a pill to help him do better in class. This after another school official told 10-year-old Marcus and his mother that he might be suffering from Attention Deficit Disorder, or ADD, and that the drug Ritalin could be in his future. "If he had (ADD), we wanted no medication," his mother, Suzy Loseke, said. As it turned out, Marcus didn't need it. He later was diagnosed with dyslexia - a reading disorder - and auditory processing difficulties. A Denver psychiatrist said that Marcus, like a lot of kids he's treated over the past 11 years, was slapped with the wrong label and nearly drugged for no reason.  "ADD is a totally meaningless diagnosis," Dr. Ron Minson said. "If you fidget or can't sit still, you have ADD."
    ADD or ADHD - Attention Deficit Hyperactivity Disorder - afflicts up to 6 percent of the population and usually persists throughout a person's lifetime, according to the National Attention Deficit Disorder Association. Someone with ADD is often easily distracted, impulsive and hyperactive to a point where it intrudes on nearly every aspect of their life, experts say. Ritalin, a stimulant, has often been used to calm the brain of people diagnosed with ADD. Around for nearly 50 years, it has plenty of proponents, including physicians and parents.
    Lizbeth Rodriguez's 6-year-old son started taking Ritalin more than two years ago. She said she's seen a marked improvement in his behavior and school performance. "He was just more hyper than the other kids his age," Rodriguez said. He wouldn't even pay attention to cars or other hazards because he was so unfocused. "It was scary," she said.
    A 1999 study, considered one of the largest of its kind, also found that Ritalin was more effective than behavior-modification therapy in treating children with ADHD. Conducted by the National Institutes of Health, the study said Ritalin was key in treating problems such as depression and anxiety in conjunction with therapy.
    Minson said he uses Ritalin in his practice, and he believes it's valuable when there is a correct diagnosis of ADD.  But he also said he has treated more than 2,000 children and adolescents for attention problems and at least half shouldn't have been taking stimulant medications. Many were actually struggling with behaviors that mimic ADD.  Minson said he helped many by using a 50-year-old sound therapy program that retrains a patient's ear to better understand what a person is saying. Developed by French physician Alfred A. Tomatis, the program helps youths overcome a host of problems that are often misdiagnosed and treated with drugs, Minson said. Some children, for instance, don't understand words and sentences because certain sounds arrive in reverse order. "Desk" may sound like "decks." Other misdiagnosed students can't process language quickly enough. They are focusing on understanding a word or phrase from a teacher and lose the next set of words in class.
    The Tomatis Method uses hearing exercises to teach a child to better process the sequence of sounds and tones, Minson said. He said he and his wife became believers in its teachings after struggling with their daughter for several years. She was "passed on from teacher to teacher," said Kate O'Brien-Minson, adding that their daughter started taking anti-depressants at 14. But she showed marked improvement after being treated with the Tomatis Method at The Center For InnerChange in Phoenix, Ariz. "She was articulate and could express her thoughts," O'Brien-Minson said.   Ron Minson said he was so impressed that he met Tomatis for a training session and opened a Denver clinic. The Minsons soon found a pool of parents willing to try something besides medication. Several parents he met said they felt pressured by teachers and counselors to put their children on Ritalin or other drugs to quiet disruptive students.   Many doctors, Minson said, don't take the time to do a comprehensive diagnosis to find out if ADD is the culprit and that drugs are the answer. "They try medication and if they (kids) do better, then they must have ADD," he said.
    In Marcus' case, he couldn't understand what teachers were trying to tell him in a local public and private school. Always fidgeting at his desk, Marcus could spell words aloud but couldn't write them on paper. After one private school teacher tagged him with the nickname "Hopeless," he became despondent, Loseke said. But he resisted taking Ritalin because he was already taking several vitamin supplements. Through the Tomatis Method, however, Marcus learned to focus better on the flood of information that comes at him in the classroom. "I'm listening to myself and not to other people," Marcus said. "I've learned to ask my teacher to tell me again or try and explain it differently."
    There are now 13 facilities using Tomatis in the United States, and plans are set for others, including one in Boulder, to be opened soon, O'Brien-Minson said. The facilities are seen as an alternative to Ritalin and other psychiatric drugs being given more and more to children with behavioral problems, she said.
    The number of youths taking mood altering drugs increased by 200 percent to 300 percent between 1991 and 1995, according to the Journal of the American Medical Association. Last year, doctors wrote about 20 million prescriptions each month for Ritalin and related drugs. Critics say the drugs can cause permanent neurological tics and can lead to a loss of appetite, depression, sleep problems and moodiness.
    Former state School Board member Patti Johnson successfully pushed for a resolution that warned against using psychotropic drugs. The resolution advocated using traditional classroom methods for behavioral problems.  Johnson said parents complained that schools were too quick to recommend drugs for hyperactive children without looking at other solutions. "When you look at a child behaving a certain way, you decide what is normal behavior," Johnson said. "If your child doesn't fit into that box, you are labeled abnormal."
    But at least one group - the National Mental Health Association - said that most mental disorders among children go largely untreated. As many as 29,500 children in Colorado are afflicted with serious emotional disturbances, but only about 9,800 are getting treatment, the organization said in 1999.
    "If stimulants are the treatment of choice, then some could make the argument that they are being underprescribed," said Dr. John Peterson, director of child adolescent psychiatric services at Denver General Hospital. He said he agrees with Minson that hearing disorders are on a long list of factors doctors must consider before diagnosing ADD or prescribing drugs. They also must rely heavily on teachers, counselors and - most importantly - parents, Peterson said. Still, he said, medications such as Ritalin can be the best way to treat ADD, he said. "Stimulants have been found to be effective and generally have also been found to have few side effects," he said.
    Teachers also rarely pressure parents to put their children on drugs, said Dr. Joe Craig, a pediatrician with Rocky Mountain Youth, a nonprofit group that treats mostly low-income families. "I've probably come across two teachers in the six years I've been doing this that are over-diagnosing," Craig said. "The rest of them are right on the money."  Many parents and kids fight the stigma of using Ritalin and ignore problems the drug could solve. "There is actually denial that someone may need it," Craig said. "They don't want that label."

Vermont Suburban School District Sees Growing Drug Problem
Associated Press, 11/18/2001

SOUTH BURLINGTON, Vt. -- It's a suburban community whose schools have a strong academic reputation, and local officials are struggling to figure out why it also has an unusually severe drug problem. South Burlington eighth-graders use hard drugs at rates double the state average, according to the 2001 Vermont Youth Risk Behavior Survey. Eighth-graders surveyed this year said they used cocaine, heroin and methamphetamines at rates even higher than students at the high school across the parking lot from Frederick H. Tuttle Middle School.
    South Burlington parents gathered last month to discuss a drug problem at Tuttle Middle School. A seventh-grade boy and an eighth-grade girl were suspended in the first month of the school year for using marijuana in the building. The number of drug violations for that month alone matched the number typical for an entire year. About 100 community members attended the meeting to talk with school administrators about the drug problem at the middle school and what can be done about it. ''Clearly, kids are experimenting with different things at younger ages than they were 10 and 20 years ago,'' said Paul Lowe, principal at Tuttle Middle School.
    Marijuana use is a big concern, said John Conroy, an assistant U.S. attorney who lives in South Burlington and prosecutes federal drug cases. He said the active ingredient in marijuana is about 10 times stronger than it was 25 years ago, making the drug potentially more addictive and dangerous. He has children in South Burlington schools and attended last month's meeting about the marijuana suspensions at the middle school. ''I pray every night that my children don't get involved in that stuff,'' Conroy said, ''but I'm no different (from) any other parent.'' South Burlington is an affluent community adjacent to Burlington, Vermont's urban center. The combination of access to money and drugs might explain South Burlington's high rate of teen substance abuse, school Superintendent Bruce Chattman said.
    Students say they often lie when answering the survey. The Vermont Department of Health, which oversees the survey, says the results are checked to exclude ''careless, invalid or logically inconsistent answers.'' Chattman said it's important to avoid overemphasizing the results. ''I think it merits attention,'' he said, ''but it's one year's data. It could be that particular group of kids.'' School counselors say the numbers are valid because they allow communities to compare. ''If they're lying, they're lying at the same rate as the rest of the nation,'' said Manon Brewer, a counselor at Milton Junior-Senior High School. Her school's eighth-graders reported high rates of cigarette smoking.
    Dayna Scott is coordinator of Connecting Youth in Chittenden South, a drug-prevention program for the schools in Charlotte, Hinesburg, Shelburne and Williston. She led a meeting of parents of middle-school students a couple of years ago and asked how many thought their children could be using alcohol or drugs. No one raised a hand. She asked how many thought other parents' children used alcohol or drugs. Several raised their hands. ''They really didn't want to believe that their kids could be using alcohol or other drugs,'' Scott said.

Stimulants for ADD Among Popular Black Market Drugs
Martha Irvine, Associated Press-11/19/2001

She had no idea she had a popular party drug on hand. To her, the vial of prescription pills she'd once been given to treat attention deficit disorder were just leftovers, until a friend from New York called to ask if she'd mail out a few just for fun. The woman, a 29-year-old San Diego resident, didn't do it. But she and her friends were intrigued. ''We said, 'We should just try it. It could be fun,''' says the woman who, on the condition that she not be named, told how they partied on the drug once this summer and again in September. In this case, the stimulant of choice was Adderall, an amphetamine. Others use methylphenidate, another attention-deficit drug more widely known by one of its brand names: Ritalin.
    Whatever the type, authorities are concerned about ADD drug abuse. Some unprescribed users are adults. But experts say many are young people a good number of them grade schoolers, who get the drugs from peers being treated for ADD. ''They've got pretty easy access to it,'' says Steve Walton, a detective with the Calgary Police Service in Canada and author of the book ''First Response Guide to Street Drugs.'' Users often crush the pills and snort them to get a cocaine-like rush. Walton says he's also found youth who frequent the rave dance-party scene ''stacking'' the drug Ecstasy with Ritalin to try and prolong their high. He calls the practice ''alarming.''
    Reports of ADD stimulant abuse continue to surface in this country, too. They include the case of two rural teens arrested in January for stealing $9,700 worth of drugs, including Ritalin and amphetamines, from a pharmacy in tiny Lacon, Ill. In March, 11 sixth-graders in Scituate, R.I., were suspended for buying and selling prescription drugs, including Adderall and Concerta, a newer form of methylphenidate.
    Surveys of young people from Massachusetts to the Midwest also have documented the trend. One of them, published in this month's Psychology in the Schools journal, focussed on 651 students, ages 11 to 18, from Wisconsin and Minnesota. Researchers found that more than a third of students who took attention-deficit medication said they'd been asked to sell or trade their drugs. And more than half of students who weren't prescribed the medication said they knew students who gave away or sold their medication.
    ''I've been trying to tell anyone who will listen,'' says William Frankenberger, study co-author and a psychology professor at the University of Wisconsin-Eau Claire. ''People don't realize what these drugs are and that the similarities between them and cocaine are much greater than the differences.''
    Officials at the federal Drug Enforcement Administration say abuse of prescription stimulants became more common in the last five years, as production of Ritalin increased and other drugs were introduced into the marketplace. But some, including doctors, wonder if new ''time-release'' versions of the drugs are slowing the abuse.  They include Concerta, taken just once a day so an ADD child doesn't have to bring the drugs to school. Time-release versions are also more difficult to crush and, thus, snort, says Dr. Timothy Wilens, a Harvard Medical School psychiatry professor. A national survey released in September by the General Accounting Office found that only 8 percent of principals said stimulant drugs were abused or stolen in their schools in the 2000-2001 school year. Most of those said they knew of only one incident.
    But Terrance Woodworth, deputy director of the DEA's diversion control office, isn't convinced that abuse is down.  In fact, he thinks the age range is expanding even as makers of some of the drugs, including Ritalin, have launched their own education campaigns to try to curb misuse. ''The kids who were abusing in junior high and high school are now in college,'' Woodworth says. That has caused some colleges, including the University of Wisconsin, to tighten prescription-writing procedures for such drugs as Ritalin, which some students call ''Vitamin R'' and use to help them pull all-nighters.
    Although alcohol abuse remains a much worse and visible problem, students on the Madison campus can only get one prescription per month and only enough pills for that month, says Dr. Eric Heiligenstein, clinical director of psychiatry at the University of Wisconsin Health Services. At Harvard, Wilens advises his patients, especially students, to ''keep their medications locked away in clandestine places so that strays don't steal it from them.'' He says those on the medication aren't usually the abusers. In fact, a study he presented last month at the American Academy of Child and Adolescent Psychiatry conference found that those who were treated with prescription stimulants were half as likely to abuse alcohol or drugs.
    For her part, the 29-year-old from San Diego says she has no plans to party with Adderall again. ''I just try to remember how I felt after,'' she says, recounting that a feeling of ''utmost clarity'' turned to insomnia and left her ''crashed out and overdone'' the following day. Then in the next breath, she admits she's kept 20 of the pills. ''I don't know why,'' she says. ''Maybe for a special occasion.''
    On the Net: DEA: http://www.dea.gov/concern/abuse/chap4/contents.htm

Psychiatrist Testifies Sharpe Was in Psychotic State When He Killed Wife
Associated Press, 11/19/2001

LAWRENCE, Mass. -- Richard Sharpe was in a psychotic state when he gunned down his estranged wife, Karen, in her Wenham home last year, a defense psychiatrist testified Monday. Dr. Keith Ablow testified that Sharpe entered into a psychotic dissociative state during dinner the evening of July 14, 2000, when he drove to his estranged wife's house and fatally shot her in her doorway. At the time of the killing, Ablow said, Sharpe ''very likely couldn't tell right from wrong,'' one of the basic criteria for an insanity defense.
    But prosecutors grilled Ablow on cross-examination, asking how Sharpe could have been insane and still performed elaborate preparations for the killing, including allegedly stealing one rifle to make the act look impulsive but using another one, as forensics experts had testified. ''Would it affect your opinion if the defendant had already had a .22 caliber rifle and took a .30 caliber rifle to make it look like the killing was spur of the moment?'' prosecutor Robert Weiner asked. ''Maybe,'' Ablow said.  The prosecution was expected to call another psychiatrist as a rebuttal witness when the trial continued Tuesday.  Sharpe continued to appear nervous, touching his face often. Ablow said that too was a symptom of his mental disorders. ''He becomes tremendously anxious,'' Ablow said. ''He doesn't like being inspected. The picking at his face is almost an attempt to remind yourself that you're still there.''  Ablow also gave his opinion of Sharpe's cross-dressing, which the defendant discussed at length when he took the stand last week. ''He's not even comfortable with his gender,'' Ablow said. ''He's not sure he likes his face, so he even had surgery to alter that,'' Ablow said. ''Dr. Sharpe's entire life has been an attempt to appear normal, and not a very successful attempt,'' Ablow said.
    Weiner has attempted to show that Sharpe is a longtime wife-beater and that the slaying was a planned act of domestic violence aggravated by an extended divorce proceeding in which Sharpe feared losing millions of dollars.  A psychiatrist called to the stand Friday by the prosecution testified that he thought Sharpe was feigning illness. Dr. Gilbert Bogen observed Sharpe at Bridgewater State Hospital after his arrest.
    Last week, Sharpe testified he began wearing women's clothes as an adolescent because of constant verbal abuse by his father. Sharpe testified that financial troubles, the impending divorce, and his estranged wife's apparent infidelities left him with a fragile grip on reality the night he killed her. Sharpe said he'd been drinking with a friend and was on numerous medications the night he killed his wife with a rifle. Sharpe said after he returned home from a night of dining and drinking, he listened to his stereo at his Gloucester home, then drove to Wenham, about 10 miles, just to talk, even though he carried a rifle to the door. Karen came to the door holding a piece of paper. After she said she would call police, Sharpe said the next thing he remembers was ''the gun going off.''