Noteworthy News Articles on Mental Health Topics, May 22-27, 2001

For Users of Heroin, Decades of Despair
Erica Goode, New York Times, 5/22/2001

"Before you know it, life just passed you up," the man said. "You lose everything. You lose your wife, you lose your family, you lose your friends." "But after seeing you go back and forth to jail over 10, 15, 20 years," he added, "they just give up on you." He was speaking of his personal war with heroin addiction, a demon he had battled for decades. And like the aging addicts described in a study appearing this month in The Archives of General Psychiatry, the man, in late middle-age, was intimately familiar with the addiction's physical and social costs.
    The study, begun in the mid-1970's by researchers at the University of California at Los Angeles, followed male heroin addicts admitted to a court-ordered drug treatment program in California in the early 1960's. The men were interviewed in 1974 and 1975 and again in the mid-1980's. The report presented the findings of a 33-year follow-up, carried out in 1996 and 1997.
    Of the 581 men in the original study, the researchers found, 284 had died, 21.6% from drug overdoses or from poisonings by adulterants added to the drug. Another 38.6% died from cancer or from heart or liver disease. Three died of AIDS. Homicides, suicides or accidents killed 55 of them. Yet as disturbing as these numbers were --the death rates were higher, by several orders of magnitude than those for the general population--the struggles of the men who were still living were equally troubling. For example, of the 242 men interviewed in the 33-year follow-up, at the time in their late 40's or mid-60's, 40.5% reported using heroin within the last year and 20.7% tested positive for the drug in the urinalysis required for the study. Abuse of other illicit drugs was also frequent (19.4% had used cocaine in the last year; 35.5% had used marijuana), as was the use of nicotine and alcohol.
    "The striking thing for me is that a good proportion of this group continues using," said Dr. Yih-Ing Hser, an adjunction professor at U.C.L.A.'s Neuropsychiatric Institute and the lead author of the study. "Ordinarily," she said, "you'd think that when people are reaching old age that they cannot continue to do the things they used to, like hustling for drugs. But that didn't happen."
    Among the men in the study who still used drugs, health problems, unemployment, criminal involvement, social isolation and broken family relationships were common, as they were for a similar group of addicted men who took part in focus groups organized by the researchers. "Some men in the study did manage to attain abstinence, and the difference was striking when they came into the interview," said Dr. Christine Grella, also an adjunct professor at the neuropsychiatric institute and an author of the study. "They were well-functioning and they looked good," Dr. Grella said. "Those who continued to use didn't look good, and they had many physical problems that were hard for them."
    The study, financed in part by the National Institute on Drug Abuse, found that even the men who achieved periods of abstinence were still vulnerable to relapse. Those who had abstained for at least five years were less likely to relapse, but even in this group, 25% resumed heroin use, some after 15 years of abstinence. And among those abstinent for more than five years, many abused alcohol or other drugs.
    The findings, the researchers said, make it clear that surmounting heroin addiction can be a long and circuitous process, and that treatment programs need to take this into account. "Most people think that those who go to treatment will be immediately cured," she said, but "heroin is a difficult drug to kick, and therefore treatment and recovery has to take incremental steps."
    Results from the 20-year follow-up, the researchers said, showed that methadone maintenance therapy helped the men refrain from heroin use. But only 10% of the subjects were enrolled in methadone maintenance in any given year. Many researchers believe that methadone maintenance therapy is an essential component of the treatment but say that, for a variety of reasons, it is often not readily available to addicts. Many programs, for example, discontinue treatment if a client fails a drug test or cannot meet the fee, Dr. Hser said. "That kind of barrier to treatment, is partly responsible for the outcome we are seeing," she said. While several national studies have followed addicts over a period of years, the U.C.L.A study is the first to track them over three decades.

The Hidden Obsessive-Compulsive Disorder
ABC News, 5/22/2001

Do you ever hate to throw something away, just in case you might need it? Take a peek at a hoarder's dining room: boxes, used fast food containers, soda cans, and an old Christmas wreath litter the floor. If you went into the basement you would find hundreds of empty boxes that Chris, a hoarder, can't bear to part with. "There is a lot of shame, and it has been like the big secret — the kids have been afraid to let other kids in the house," Chris tells Good Morning America. She and her family asked that their last name not be used. "I keep it from most of my friends, and they don't come over to my house at all, and it's really difficult because I know they wonder, why don't we go to Katie's house," Katie, her daughter, says.
    It's because of an obsessive-compulsive disorder doctors call "hoarding," a secret shame that happens behind doors firmly closed. Those who suffer from this little-known syndrome find it emotionally and physically impossible to throw anything away. Doctors aren't sure what causes hoarding, though some 50 studies have been done on the disorder, ABCNEWS' Dr. Nancy Snyderman says. It has been linked to a variety of mental illnesses including schizophrenia, but many experts believe it is a type of obsessive-compulsive disorder. Obsessive-compulsive disorders affect some 2 million Americans. Hoarding seems to affect equal amounts of men and women. One study found that 80 percent of hoarders had grown up in a house with someone who hoarded, Snyderman said. A study at UCLA used Pet scans to get a closer look at hoarders' brains, and they have found some brain differences, she said.  Experts who study hoarding say the problem goes largely unreported, and is often only revealed because the hoarder faces eviction, a competency hearing, or action by a local health department.
    Chris' family has never known a life without it. "I really hate this, that I have such a hard time throwing things away," says Chris, "it's pure agony is what it is ... it's pure agony." Her husband gradually realized that there was a problem. "I kind of noticed that there was something going on where for me putting out garbage was very simple and no big deal and where Chris had some reservations," says her husband, Wayne. "A lot of times ... well it would just stay in the house until I really felt comfortable about letting it go," Chris says. People who hoard wall themselves into a maze of meaningless possessions. Chris tried to throw away a cereal box a year and a half ago, and couldn't. Such objects take on an abnormal degree of sentimentality so that hoarders can't make decisions about what to keep and what to throw away. And tossing things out, even if they are obviously trash, make them anxious and desperate.
    But Chris is getting help from Dr. Randy Frost, a psychiatrist from Smith College who agreed to come to her home to help her. "There are a couple of general manifestations we normally see in hoarding and she has all of them," he says. They include:
Compulsive acquisition — hoarders acquire extras of things, just in case, more than they'll ever use.
Disorganization — hoarders find organization difficult, so things end up in haphazard piles.
Difficulty discarding — they really can't throw anything away without severe anxiety.
Frost carefully walks Chris through an exercise in which she chooses to throw just one item away, such as an empty snack container. "Remember, don't check," he tells her. "Just throw it away."
    Frost's method is known as cognitive behavioral therapy. Physically practicing throwing something away may be the only thing that works for patients who hoard. And researchers are on the road to figure out why. "I would sit and look and not know what to do and I would just cry," says Linda, a hoarder who is in recovery. It has made a striking difference in the appearance of her home. "Yeah, yeah, I can't believe that I didn't do this before, I just didn't know how," she says.
    At Boston University's Center for Anxiety Disorders, hoarders learn to make decisions, and practice how to let go of objects without distress, cheering each other on as they throw out items. Linda spent three months at the center in group therapy. "I really look forward to going on Wednesday nights, you know, being with this group," Linda says. "And I'm just so thankful that I found them" Chris will begin regular therapy in a few weeks. She and her family don't want to hide any more. Chris' problem came to a head when the Board of Health asked her to leave her home, and had her children stay with other people. When they came back to the house, they expected to find it neat, but they did not understand that Chris was suffering from a mental health problem.
    Now, Chris says she wants to be able to open her mini-blinds and let the sun shine. Her husband also wants a return to a normal life. "[We want] to have our lives back, to have our house back and to be able to not deal with the secret any more," he says. "I see a big family reunion here in my house and a big, big get-together with all the people too that have helped," Chris says. "I think that would be the neatest thing."

Are You a Hoarder?
A lot of us collect or save piles of things — so what is it that makes hoarding different? Most collectors have an order, or a pattern to the items that they collect, ABCNEWS' Dr. Nancy Snyderman says. If someone cannot find his or her way through the clutter in a reasonable way, however, there is a cause for a concern. One way of distinguishing a hoarder is if the messiness begins to have a negative impact and keeps them from a normal life.
    Another sign is if you begin to have an unreasonable attachment to things. Hoarders get to the point where they can no longer use living spaces for the purposes for which they were designed, Snyderman says. Instead, items are stored in the oven, kitchen sink, or bed. People with serious hoarding problems also seem to have difficulty making decisions.
    Hoarding often becomes apparent in late adolescence, but it can be triggered by a traumatic event, such as the death of a loved one or a divorce. People start collecting things to remember that person. Hoarders can also specialize, developing a passion for certain objects, whether tools, soda cans, newspapers or even animals. People who have dozens of cats, for example, are considered hoarders, Snyderman says. Hoarders often don't get help until a public health official is called in, as in Chris' case. Cognitive behavioral therapy, as described above, is really the primary form of therapy. Hoarders have to learn how to throw things away. Anti-depressants are also prescribed, but Snyderman says you don't want to take medication that will hide the problem, so medication without therapy doesn't make sense.

Study Finds Gambling, Cocaine Affect Same Region of Brain
Patricia Wen, Boston Globe- 5/24/2001

Scientists don't need to visit the crowded Foxwoods casinos to prove that people get high on gambling - especially when they win. Now, they've got brain scans showing that gambling activates the same regions of the brain as snorting cocaine. A new study at Massachusetts General Hospital shows that a common mental circuitry - involving six small regions in the middle of the head - lights up during these two activities and may help ultimately explain addictive behavior. ''We cannot distinguish any difference between the brain pattern of someone while gambling or ingesting cocaine,'' said Dr. Hans Breiter, a neuroscientist at Mass. General who previously monitored the brains of cocaine users. ''And whatever areas are involved in addiction affect these regions.''
    The gambling study, published in today's issue of the journal Neuron, also shows that even the hope of a big win increased the blood flow to this region of the brain. Breiter said the research has implications far beyond addiction research. In the future, companies might not have to rely on what consumers said when asked if they liked red or black sports cars. They could know through brain scans. ''Imagine the implications for marketing,'' Breiter said. ''This opens up the field of preference.'' His work is part of the expanding area of brain research that targets the human response to everything from romance to religion. Breiter's work, done with Mass. General colleagues, as well as scientists at Princeton University and Concordia University in Montreal, helps draw a line around those brain regions that may be involved in intense emotion, rewards, and addiction, and lead to new treatments.
    In the case of gambling, many people may benefit from this kind of research: In Massachusetts alone, roughly 250,000 people are believed to have a moderate gambling problem, such as losing a significant amount of money for their budget or suffering an emotional setback from betting, state officials said. About 70,000 state residents are believed to be ''compulsive'' gamblers who would sacrifice food and shelter just to gamble. Therapists hope that new treatment will go beyond the Gamblers Anonymous self-help groups. ''All of this research advances our knowledge of the biological mechanisms involved in various addictions,'' said Dr. Paul Laffer, who runs a gambling addiction program at Mount Auburn Hospital in Cambridge. ''Perhaps new drugs will be developed as a result and become a piece of treatment.''
    Studying this region of the brain may also lead to insights about drug abuse. Breiter and others say drug addicts may have a faulty brain mechanism linked to judging life's rewards, and see cocaine or heroin as offering more reward than a meal. Breiter's study monitored the brain activities of 12 ordinary adult men, between the ages of 20 and 35 with no history of gambling problems. Through a process called high-field functional magnetic resonance imaging, the researchers mapped the brain activity of the volunteers as they participated in a game of chance. Each was given $50, and, in 12-second intervals, was shown a computer image of one of three spinners, each offering monetary wins or losses. There were three kinds of spinners: the ''good'' offered mostly winning opportunities, up to $10; the ''bad'' offered mostly losses, up to $6; and the ''intermediate'' was a mixed bag. The volunteers knew from the beginning of each turn when they stood mostly to gain, or lose, or faced mixed possibilities. During the experiment, volunteers registered more intense reactions when shown the ''good'' spinner, even when the pointer hadn't landed on a result yet. And of course, the volunteers had a more intense reaction if they got a big win. But there was also an intense reaction when the ''bad wheel'' ended up with a nominal or no loss, illustrating the benefits of low expectations. If the volunteer lost little when he feared losing a lot, they interpret the result as ''a gain,'' showing the brain plays a role in assessing a relatively good outcome.
    Breiter said he and his colleagues hope to be able in the years to come to distinguish the exact role of each of the six brain regions involved in rewards or pleasures. He said some probably have more to do with creating response, while others help rank preferences. Researchers say this type of research can be a baseline for future research on addicted gamblers. Do compulsive gamblers show more intense activation in pleasure areas? Are they unable to think rationally about gains and losses? ''We'll want to know if we can see reliable differences in brain responses of the addicted,'' said co-author Peter Shizgal, director of the Center for Studies in Behavioral Neurobiology at Concordia University. Ultimately, Breiter believes this reward area of the brain can explain the very foundation of human behavior. ''This circuitry is at the core of everything we do,'' he said. ''It's the information backbone for motivation.''

Lawmakers Propose 'Scarlet Letter' License Plates for Drunken Drivers
John Mcelhenny, Associated Press- 5/23/2001

BOSTON-- Massachusetts lawmakers are considering a sort of ''Scarlet Letter'' license plate for drunken drivers.  Legislators are scheduled to take up a proposal Thursday requiring anyone convicted of driving under the influence at least twice within 10 years to have special ''OUI-2'' plates, for Operating Under the Influence. Republican state Sen. JoAnn Sprague, sponsor of the proposal, said the special plates would allow police to keep a closer eye on offenders and could dissuade some people from drinking and driving. The proposal also would increase the minimum penalty for second convictions from 60 days in jail to one year. ''If they don't want a license plate,'' Sprague said, ''they should not drive under the influence of drugs or alcohol.''
    Other states such as Ohio, Oregon and Minnesota have experimented with special striped license plates for repeat drunken drivers. Georgia lawmakers are considering a proposal to force offenders to display a scarlet letter ''D'' for ''drunk'' in their rear windshields. ''It's like having a sex offender in your neighborhood. People should know about it,'' Adeline Rotondo, a mother of two, said of the Massachusetts idea.
    Bill Redfern, a supervisor at a financial company, called the proposal archaic. ''It's like the `Scarlet Letter,''' said Redfern, 28. ''If you're going to punish somebody, punish him, but don't make a spectacle out of him.'' John Roberts, executive director of the American Civil Liberties Union of Massachusetts, said such a plate would stigmatize not only the offender but also any family member who drove the car. ''We thought the public pillory on Boston Common had been done away with for good reason,'' Roberts said. The proposal is given little chance of success in the Legislature. ''We have such a strong civil liberties environment that the idea of marking people and setting them up for a police stop is not going to work,'' said Barbara Harrington, executive director of Mothers Against Drunk Driving in Massachusetts.

Analysis Challenges 'Placebo Effect'
Susan Okie, Washington Post- 5/24/2001

Surprising new evidence has called into question the existence of the "placebo effect," the widely accepted principle that people with various illnesses will often improve if given a dummy pill or a sham treatment. For a half-century, doctors have been taught that this phenomenon is partly responsible for drugs' effectiveness. Researchers have taken it into account when testing new medicines. Biologists and psychologists have searched for its cause. Ethicists have even debated whether doctors could justifiably deceive patients to take advantage of it.
    But in the most comprehensive effort yet to evaluate whether placebos work, Danish researchers conclude that they have little effect after all and should not be used outside research settings. Their analysis examined 114 studies of various symptoms or disorders and found that the placebos were no better than no treatment for most of the problems studied. Placebos did appear to produce modest benefit in studies of pain and in some other studies where the outcome being measured was similarly subjective.
    The ethics of placebo use -- both in medical practice and in research -- have been hotly debated in recent years. In addition, proponents of alternative therapies often point to patients' response to placebos as evidence of the mind's power to heal, and much research has focused on understanding and possibly harnessing that response. "I'm surprised by this," said David Spiegel, a professor of psychiatry at Stanford University School of Medicine. "What this shows is not that [the placebo effect] doesn't exist, but that it doesn't answer all problems. We need to look more carefully at effective and ineffective components" of the response to placebos.|
    The report should change the way doctors make decisions about treatment, said John C. Bailar III, a professor emeritus of health studies at the University of Chicago who wrote an editorial accompanying the study in today's issue of The New England Journal of Medicine. "Now. . . . anybody who says there is a placebo effect has the burden of proof," Bailar said. "I think it's going to have quite a substantial effect on how medicine is practiced, particularly non-research medicine." Doctors give a placebo whenever they prescribe a drug merely to placate a patient, without any evidence that it is necessary or effective, Bailar noted. "I think placebos are used all over the place," he said. "An outstanding example is the prescription of antibiotics for the common cold, which is a viral disease" and therefore unaffected by antibiotics.
    The idea that placebos have a powerful, scientifically measurable effect dates from a 1955 medical article by Henry Beecher. Beecher claimed that in 15 clinical trials, roughly one-third of patients responded to a dummy treatment. To take this phenomenon into account, he argued, researchers should evaluate new drugs by testing them against a placebo in clinical trials. In the decades since, people have come to equate the "placebo effect" with the positive change often observed in patients given a placebo in such studies. But such patients may improve for many other reasons, such as the tendency of most illnesses to resolution on their own or the wish to please the doctor by reporting benefits from treatment.
    "It doesn't make any sense to call it a 'placebo effect' as if you imply some kind of causal relation," said Asbjoern Hrobjartsson of the University of Copenhagen and the Nordic Cochrane Centre, the new study's principal author.  To investigate whether dummy treatments could be beneficial, Hrobjartsson and colleague Peter C. Goetzsche undertook an international computer search for studies done since the 1940s in which some participants were randomly assigned to receive a placebo and others were assigned to get no treatment. They analyzed outcomes of 114 randomized trials involving 8,525 participants with diverse medical problems. The placebo could be a dummy drug, a physical manipulation or a psychological intervention such as a conversation. Outcomes could be either binary (for instance, presence or absence of infection) or continuous (such as partial improvement in a symptom). The study was done as part of the Cochrane Collaboration, a loose-knit international association of researchers and statisticians whose goal is to extract "bottom-line" information from the often contradictory results of published medical studies.
    Compared with no treatment, placebos had no significant effect either on binary outcomes or on continuous outcomes where the result was measurable (such as weight loss). Placebos appeared to produce some benefit only in studies with continuous outcomes that were subjective -- that is, reported by the patient. Among individual conditions, only pain showed evidence of a modest but significant placebo response. Even for pain, "I'm very much in doubt" whether the effect is real, Hrobjartsson said. "The difference between placebo and no treatment could also reflect reporting bias" on the part of study participants.
    There is fairly good evidence from other research that placebos can relieve pain, but little proof that they work for other conditions, said Robert J. Temple, director of medical policy at the Food and Drug Administration's Center for Drug Evaluation and Research. "I think it's a terrific thing to have done," he said of the Danish study, "but I have to tell you I'm not the least bit surprised" by the conclusions. Temple noted that the report does not address placebos' role in studies to test new treatments. Typically, one group of participants receives an experimental drug and another group receives a dummy pill that looks identical. This strategy prevents participants and researchers from knowing who is getting the drug, thus avoiding bias that might influence the results. Most experts consider such studies ethical provided that participants understand that they may receive a placebo and that participants are not harmed by being denied an effective treatment for a serious disease.
    Ted J. Kaptchuk, an assistant professor of medicine at Harvard Medical School who has done extensive research on placebos, said some other evidence contradicts the Danish study's conclusion that placebos are ineffective. "There have been several studies that compare two different kinds of placebo, like a needle versus a pill," Kaptchuk said. "They consistently show that a device has a bigger effect than a pill. If a placebo has no effect, [changing the kind of placebo used] should have no effect."

New Warning Labels for Alcohol Considered
Associated Press, 5/24/2001

Warning labels on beer, wine and liquor would be easier to find and read under rule changes being considered by federal regulators. The Treasury Department's Bureau of Alcohol, Tobacco and Firearms is exploring a proposal offered by a coalition that includes the Center for Science in the Public Interest and the National Council on Alcoholism and Drug Dependence.
    The proposal, submitted to the agency in November 1999, provides four main recommendations on making the labels more prominent. They urge that the current health warning label:
• Appear on the front of the container in a horizontal position.
• Appear in red or black type on a white background and be surrounded by a lined border.
• Make the first two words of the label -- "government warning" -- appear in capital letters and boldface type that is at least 15 percent larger than the rest of the text in the statement.
• Feature next to the text of the warning an icon showing a triangle with an exclamation mark inside.
Current regulations don't require that the health warning label appear in a specific place on the container. Given that, the labels can appear in myriad ways.
    Art DeCelle, general counsel of the Beer Institute, and Frank Coleman, a spokesman for the Distilled Spirits Council of the United States, said their groups are reviewing the matter. ATF said yesterday that it wants public and industry groups to weigh in on the proposal by Aug. 20, before it makes a final decision. Congress created the labels, intended to cut down on drinking by pregnant women and motorists, in a 1988 law. ATF issued regulations implementing the law in 1990.

Studies Find Rural Teens Getting Hooked on Heroin
Dean Schabner, ABC News- 5/24/2001

The mountains of Colorado and Vermont have long drawn skiers, hikers and nature lovers. Lately, an unwelcome guest has been showing up more and more in these pastoral settings: Heroin. Colorado and Vermont, like rural and suburban areas from Wisconsin to Texas and New Jersey to Oregon, have seen a boom in heroin use, particularly among the young, over the last five years, catching communities unprepared for the scourge.
    The impact of heroin addiction was brought home to Vermonters when police linked the death of a teenage girl in a New York City brothel to what they said was a prostitution ring running from Burlington, Vt., to the Bronx. Police said Vermont girls got hooked on heroin that was introduced to the area by dealers from New York and then were lured into prostitution with promises of money and drugs.
    It's a pattern that has been observed all across the country. "Heroin dealers are dealing and marketing to young people," said Gladys Zelman of Maple Leaf Farm, a substance abuse treatment center in Vermont. "There's no question it's here, it's damaging and kids are dying." What has been observed over the last several years is a sharp reversal of the trend over the previous 15 years, when heroin use was on the decline and was virtually unknown in most rural areas of the country.
    The revival is blamed in part on the arrival of black tar heroin on the American market, which is often as much as 70 percent to 90 percent pure, allowing new users afraid of injecting the drug to get a powerful high by smoking or inhaling. There's another, older force driving the boom, though. Boredom. "I asked a young person what to do about it and she said, 'Well, we're bored. We need transportation to get to places, to do things. We need to have other things to do,'" Zelman said.
    It hasn't helped that the price of heroin has tumbled, even as purity has soared. "What we've noticed here is that there's definitely been an increase in heroin use among the kids we deal with," said Jamie VanLeeuwen, a program coordinator at Urban Peak, which runs the only licensed homeless and runaway youth shelters in Colorado. "A bag of heroin — good for a weekend high — goes for $20 to $40. That's not an expensive high."
    In Vermont, heroin is often introduced by visiting dealers from Boston, New York or New Jersey who might even hand out free samples, get a few kids hooked, then return to their urban homes and let their new clients come to them. Those first new addicts then become dealers or prostitutes to support their own habits. "We've seen more women, young girls addicted to heroin than ever before," Zelman said. "They are prostituting themselves to keep up their habits. And they sell the drug themselves, so the dealers aren't even really around. It's a pyramid."
    Separate studies of drug use in Vermont, New Jersey and Colorado this year confirm what a Center on Addiction and Substance Abuse study found last year — that smoking, drinking and drug abuse are all more prevalent among teenagers in rural America than in the major cities, and heroin use is soaring outside of urban areas. According to the CASA study, eighth-graders in rural parts of the country are 83 percent more likely to smoke crack cocaine, and 30 percent of people surveyed in rural and suburban areas said heroin was "very easy" to get in their town.
    Since 1996, the White House Office of National Drug Control Policy has added Iowa, Kansas, Nebraska, South Dakota, Kentucky, Tennessee and West Virginia to its list of High Intensity Drug Trafficking Areas. The studies in Vermont, Colorado and New Jersey were all done among people entering treatment for drug or alcohol abuse. In Vermont, according to the state Department of Health, the number of 18- to 24-year-olds seeking treatment for heroin addiction jumped from 22 in 1997 to 124 in 2000. In Colorado, state admissions for heroin treatment among 18- to 25-year-olds increased from 148 in 1993 to 346 in 1999, and as a percentage of total admissions for substance abuse rose from 8.9 percent to 16.7 percent over the same period.
    "When you see that big an increase in young users, it is an element of concern," said Bruce Mendelson, a data analyst with the Colorado state Alcohol and Drug Abuse Division, which did the study in that state, released this month. "While the numbers aren't large, it's of concern, particularly when you're seeing it spread to suburban users who might think when they're smoking or inhaling it it's not addictive, but that's just not true."
    The numbers, however, are larger in New Jersey. A study released last week by the federal Centers for Disease Control said that in rural and suburban areas 691 18- to 25-year-olds were treated for heroin addiction in 1993. By 1999, the number jumped to 1,817. In urban parts of the state, the trend was the opposite, with 2,018 young city dwellers receiving treatment in 1993, and 1,076 being admitted to treatment 1999. Also over that time span, the percentage of all users who took heroin by injecting it jumped from a third to half. The CASA study found that rural communities and small and midsize cities are unprepared to deal with the consequences of the rise in drug abuse.
    In Vermont, the death of 16-year-old Christal Jean Jones spurred the state government to address the problem, with the Legislature drawing up proposals for funding projects, and a commission being convened this summer by Gov. Howard Dean to look at broad social issues related to troubled youth. VanLeeuwen and Zelman both said there is a desperate need for more treatment facilities in their states, and for government to focus more on prevention and treatment than punishment. "Let's address this problem and treat it early so we don't start seeing the other side," VanLeeuwen said.

Judge Buys Shopaholic Defense in Embezzling
Matt O'Connor, Chicago Tribune- 5/25/2001

A Chicago woman who stole nearly $250,000 from her employer to finance a shopping addiction was spared from prison in a novel ruling Wednesday by a federal judge who found that she bought expensive clothing and jewelry to "self-medicate" her depression. Elizabeth Roach racked up credit-card bills up to $500,000, buying a purse for $9,000, a belt buckle for $7,000, hundreds of designer outfits and dozens of pairs of shoes at upscale stores, according to court records. Lawyers for both Roach and the government said they believe the ruling by U.S. District Judge Matthew Kennelly marks the first time in the country that a federal judge reduced a defendant's sentence because of an addiction to shopping.
    Roach faced up to 18 months in prison under federal sentencing guidelines. But Kennelly granted the defense what is known as "a downward departure," ruling that Roach suffered from "a diminished mental capacity" that contributed to the commission of the crime. As a nervous Roach tightly held her lawyer's hand, Kennelly sentenced her to five years' probation, six months of weekends confined to her home on electronic monitor and six weeks incarcerated in a Salvation Army work-release center. "You're going to be spending your vacation this year and next year at the Salvation Army center," the judge told Roach, 47, who is employed as a $175,000-a-year consultant.
    Kennelly also fined her $30,000, ordered her to continue psychiatric counseling and forbade her from signing up for new credit cards or incurring additional debt without his permission. The judge said there was no merit to sending Roach to prison because incarceration would only disrupt her therapy. Roach made no comments in court but, during a hearing last week, apologized for her actions.
    In a lengthy decision from the bench, the judge said he found her chronic depression "the driving force" behind her thefts. She tried to "self-medicate" by compulsively shopping and then padding her expense accounts at work to conceal huge shopping bills from her husband and others, the judge said. Roach didn't even wear much of the clothing and jewelry, hiding them from her husband for weeks and then--because she was unable to return them to stores--selling them to resale shops and pawnbrokers at a fraction of their value, according to her lawyer, Jeffrey Steinback. "It is not about getting things," Steinback said of Roach's compulsive shopping. "It's about trying to find a way to deal with the pain."
    By selling stock given to her by her grandfather and putting a second mortgage on her Astor Street condominium, Roach has already paid full restitution to her former employer--Andersen Consulting, now known as Accenture--Steinback said. In pleading guilty to a single count of wire fraud last June, Roach admitted she stole $241,061 over three years, mostly by falsely claiming to have attended out-of-town conferences, putting in for expenses and receiving reimbursement for air fares the company had already paid.
    According to Steinback, compulsive behaviors, particularly addiction to gambling, are increasingly being taken more seriously by federal courts at sentencing. Federal sentencing guidelines forbid defendants who abuse drugs or alcohol, though, from qualifying for downward departures. Steinback and Assistant U.S. Atty. Joel Levin, who prosecuted Roach, both said their separate legal research found only one published case similar to Roach's.  In that federal case in New Jersey, the defendant pleaded guilty to embezzling $12 million from his employer over nine years and admitted that he had used the money to satisfy an obsession with buying and restoring antique clocks.  But the judge in that case refused to reduce the sentence.
    In Roach's case, after psychiatrists hired by the defense all agreed that she couldn't control her shopping addiction, Kennelly had postponed sentencing and ordered an independent expert to assess her. That mental-health expert, paid for the government, came to the same basic conclusion as the other psychotherapists, that Roach suffered from serious emotional problems that contributed to the commission of the offense, Steinback said. Roach's treating psychiatrist, Dr. Arnold Goldberg, speaking generally about compulsive disorders, said in a telephone interview Wednesday that shopping is just one of many pleasurable activities--such as sex, eating, gambling and alcohol and drug consumption--that can slip into addictive behavior. Goldberg, a professor of psychiatry at Rush-Presbyterian-St. Luke's Medical Center, said some addicts go through something like a feeling of disassociation in which they lose sight of reality and feel compelled to carry through on their compulsion and then are overwhelmed with shame and guilt.
    According to court filings, Roach had a troubled childhood. The only way her emotionally distant father showed his affection when Roach was an adolescent was to give her money and credit cards for shopping, one psychiatrist noted. Her shopping binges began in college and contributed to the end of her first marriage, according to Steinback. She has undergone therapy for 17 years. "I wanted to feel better, to stop the sadness and depression," Roach wrote in court papers of her compulsion to shop. "It only made it worse."
    A short time before Andersen Consulting fired her, Roach was arrested for shoplifting at Nieman Marcus, pleaded guilty and was sentenced in Cook County Circuit Court to probation. Steinback said Roach has amassed a $500,000 debt from her shopping binges, spending upwards of $30,000 to $50,000 a month at times. In one trip to Nieman Marcus, she bought a belt buckle for $7,000 and a pair of earrings for $3,000. She owned 70 pairs of shoes at one time. In one trip to London, she got so caught up in her shopping that she lost track of time and missed her flight home, Steinback said. Her shopping bill in London totaled about $30,000, he said.
    Despite her well-paying job, she borrowed from friends and family to make the purchases and maxed out numerous credit cards. Yet she never wore many of the designer clothes, hiding them in her closet to keep the purchases from her second husband, Steinback said. After weeks of worrying, she would beg the stores to take back the clothing, but many times she was forced to sell them to resale shops at drastically reduced prices, Steinback said. She was on a first-name basis with a local pawnbroker, he said. She was able to get only $200 for the $7,000 belt buckle, Steinback said.   Steinback said medication and psychotherapy have kept Roach's illness in check for the last two years, though she has had a few slips of binge shopping. "It's going to be a daily struggle," he said.

Web's Medical Sites Found Lacking
Tony Pugh, Detroit Free Press- 5/25/2001

WASHINGTON -- The nearly 100 million Americans who turn to the Internet for medical advice should get a second opinion.  While generally accurate, online health information often is incomplete, confusing or contradictory, according to a study reported Tuesday and published in this week's Journal of the American Medical Association. The problem is worse on Spanish-language Web sites, experts concluded.  Their findings are likely to frustrate people who turn to the Internet for health advice because their doctors are too busy sometimes. While they are convenient, informative and immensely popular, health sites are not to be relied upon, concluded panels of doctors who examined sites and search engines in a survey conducted by the Rand Corp., a Santa Monica, Calif., think tank. "What we found on the whole is that there are gaps in the information provided," said Dr. Leo Morales, the report's coauthor. With rare exceptions, he added, "They're all doing an equally poor job."
    The Rand study, titled "Proceed with Caution," found that most English-language sites offered only about 70 percent of the minimum information needed for readers to make intelligent decisions about their health care. Spanish-language sites, provided only about half the needed information. Limited translating capabilities would help explain that, Morales said. To compare 25 leading e-health sites, researchers looked at their information about four health problems: obesity, depression, breast cancer and childhood asthma.
    Some of the missing information was medically significant. For instance:
Few sites urged that a woman with a persistent breast mass and a negative mammogram get further evaluation.
Few Spanish-language sites explained that treatment options for early-stage breast cancer included mastectomy and lumpectomy plus radiation.
Almost no sites described the symptoms of a life-threatening asthma attack
Almost none urged people with suicidal thoughts to seek care immediately.
"If people rely on the Internet to guide their decisions about when to get care, these failures could have serious consequences," the report stated.
    Flawed or not, Internet health sites influence the medical decisions of about 70 percent of people who use them. Another study found that a quarter of Hispanics use the Internet for health information. "Unfortunately there's a lot of junk information out there and we don't want anyone to self diagnose or treat themselves based on information found on the Internet," said Dr. Donald J. Palmisano of New Orleans.
    Conflicting health information is especially troublesome, said Dr. Gretchen Berland, the study's principal investigator. A childhood asthma site she examined reported in one place that inhaling steroids wouldn't stunt a child's growth but in another said it would. Other conflicts involved recommended treatments, definitions of diseases and adverse effects and risk factors. "E-health will not go away and it has the potential to be a revolutionary technology," Berland said. "But some changes need to be made to make the information more reliable." The American Medical Association urges consumers to discuss Internet findings with a doctor or other health professional before acting on them.
    The best sites in the Rand sampling were Oncolink.com, the University of Pennsylvania's breast cancer Web site, and Nimh.nih.gov, a depression Web site operated by the National Institutes of Health. Only four English-language Web sites offered more than 80 percent of the minimum information needed, according to the study panel. They were breast cancer sites Oncolink.com, Cancernet.gov and Webmd.com and a depression Web site at NIMH.nih.gov.

Consumer Groups Sue Pharmaceuticals
Theresa Agovino, Associated Press- 5/25/2001

NEW YORK –– Lyn Lovinger was angry when a series of changes in her insurance policy tripled the cost of her breast cancer medication. The $25 a month charge may not sound like much, but the retired community services employee lives in New York in low income housing and on a very tight budget. "I'm lucky I can afford the medicine, but it is always on your mind that you may need another drug or that something else in your life could change, and then what?" said Lovinger, who was diagnosed with the disease in 1997. She says a pharmacist told her that a deal between a pharmaceutical company and a generic drug manufacturer blocked the introduction of a low-cost generic version of her medication tamoxifen. She made endless calls to various agencies and legislators to protest the high cost of the drug. A few months ago, a representative of a senior citizens' group asked Lovinger if she would consider being a named plaintiff in a class-action suit. She immediately agreed to help. "I was fighting on my own for months," she said. "I was just so happy someone wanted to help me."
    Consumer groups all over the country have started filing lawsuits to stop what they say are illegal actions by the pharmaceutical companies, and sometimes generic firms, that squelch competition. Two separate coalitions have been formed to organize the effort – Washington, DC-based Stop Patient Abuse Now, with 33 members, and Boston-based Prescription Drug Access Litigation Project, with 17 members. These lawsuits exacerbate the pressure on an industry already under the microscope. Drug company activities are under investigation by the Federal Trade Commission and the Justice Department.
    Attorneys general from 15 states last week filed a federal suit in Detroit against drug company Aventis SA and generic maker Andrx Corp., charging they stifled the introduction of a generic version of the popular heart drug Cardizem CD. And activists continue to demand less expensive drugs for ending the AIDS pandemic in Africa.
    But the consumer lawsuits represent a special challenge for drug companies because now they are being sued by the very people they are in business to help.   "It is just not an attractive situation to get sued by your customers," said Gerald Sobel, a patent lawyer at New York-based Kaye Scholer, which represents many pharmaceutical companies. "In one respect these lawsuits are really ungrateful. Without these drugs these people could be dead." And while he wouldn't enjoy cross-examining someone like Lovinger, neither would he advise a settlement if no laws had been broken. "If the drug companies are right, they should have a chance to prove they are right," Sobel said. "Legal points don't always correspond with good public relations."
    Lovinger's case, filed in federal court in New York last week, joined more than a half-dozen lawsuits against pharmaceutical giant AstraZeneca PLC and generic firm Barr Laboratories Inc. Some of the other plaintiffs include the New York State Senior Action Council and Boston-based Health Care For all. The suits allege the companies colluded to keep a low-cost version of tamoxifen off the market. Barr had won a patent challenge, but then agreed to accept $21 million from the AstraZeneca and work with it to sell tamoxifen, the generic version of the branded breast cancer drug Nolvadex. Tamoxifen is only about 5 percent cheaper than Nolvadex. Generics are usually 50 to 80 percent cheaper than the original.
    Several consumer groups, including the Washington D.C.-based Gray Panthers and the San Francisco-based Senior Action Network, have filed suits against Bristol-Myers Squibb Co., alleging it conspired to keep a generic version of its antianxiety drug BuSpar off the market. And the National Organization of Women plans to sue Bristol-Myers for allegedly stifling a generic version of Taxol, a popular breast and ovarian cancer treatment. In the two Bristol-Myers cases, the plaintiffs claim the drug company added irrelevant patents to the drugs to extend their product cycles. AstraZeneca and Barr have denied the charges. Bristol-Myers didn't return phone calls.
    Consumer groups' money and time would be better spent lobbying Congress for programs to expand access to drugs instead of suing pharmaceutical companies, said Marjorie Powell, assistant general counsel of the Pharmaceutical Research and Manufacturers of America, the industry trade group. "I think using lawsuits and the federal courts to institute policies is wrong," she said. "All of these lawsuits detract from efforts to expand drug access for seniors."
    Consumer activists counter they've turned to the courts because lobbying has proven useless against the pharmaceutical industry's clout. Drug companies spent $91 million – more than any other industry – on lobbying in 1999, the last year for which statistics are available, according to the Center for Responsible Politics. "The lobbying money has barred reform," said NOW President Patricia Ireland. "The pharmaceutical industry carries bags of money up to (Capitol Hill). You have to find ways to counter that. The judicial branch can be more level playing field.
    Tim Fuller, the Gray Panthers executive director, hopes the lawsuits will embolden consumers to talk to their elected representatives. "I think Congress will take notice of these lawsuits because they are consumers," said Fuller.   This could prove critical as the pharmaceutical industry works to defeat a bill introduced last month by Charles Schumer, D-N.Y. and John McCain, R-Ariz. The bill aims to get generic drugs into pharmacies quicker by eliminating automatic stays granted to pharmaceutical companies that sue generics for patent infringement. It would also allow generic companies to approach judges directly to see if their formulations infringe on existing patents.
    Cranking up lobbying funds could backfire, however.   "Pharmaceutical companies don't want to look like they are buying Congress," said Mara Goldstein, executive director of CIBC World Markets. She adds that if consumers become more vocal about their desire for cheap drugs, it could pose a problem for legislators who have been sympathetic to pharmaceutical firms.   Pharmaceutical executives doubt lobbying efforts will subside. Rather they say it is important to keep reiterating the message that the revenues from pharmaceutical sales fund research and development. "The consumer efforts are shortsighted. You don't want to kill the goose that lays the gold eggs," said Sobel.
    Consumer groups counter that there is a difference between earning a reasonable profit and gouging consumers. Fuller said the recent pressure on drug companies to lower the prices of AIDS drugs for Africa illustrates just how cheaply generics can be manufactured and highlight the profits pharmaceutical companies earn off just one drug.   "The AIDS situation blew the lid off just how much these companies make," said Fuller.  The lawsuit the Gray Panthers filed against Bristol-Myers over BuSpar seeks $600 million in damages. Fuller makes no apology for seeking funds and doesn't worry about appearing like a corporate golddigger. "It is the consumers' money," he said. "Besides, money is what drug companies understand."
    On the Net:
http://www.prescriptionaccesslitigation.org
http://www.phrma.org
http://www.span.org

The Search for Genetic Keys to Alcoholism
Jamie Talan, Newsday- 5/25/2001

NEW YORK--Scientists are beginning to unravel the complex relationship between genes and behavior to understand alcohol addiction. The hope is to design treatments to block excessive drinking. "We have a difficult challenge," said Dr. Enoch Gordis, director of the National Institute on Alcohol Abuse and Alcoholism, at the centennial anniversary lecture recently at Rockefeller University in Manhattan, where the first methadone program was developed in the 1960s to treat heroin addicts. Gordis pointed out that alcohol affects every receptor system in the body, making it unlike other drugs, which target only a few key pathways. Alcoholism is very common, affecting about 12 million men and 8 million women in the U.S. A recent count of patients at Johns Hopkins Medical Institutions in Baltimore revealed that one-quarter of the beds were filled by people sickened as a consequence of their drinking.
    If alcoholism can be inherited, as studies of twins and adopted children have repeatedly shown, then what exactly is passed down? Is it a gene that regulates the brain chemical dopamine that affects how one experiences pleasure? Is it a gene that makes some people less, or more, sensitive to the powerful chemicals that make up alcohol? Is it a gene that modulates preference? Is it a mix of genes and powerful environmental forces? Scientists are focusing their search on genes that alter brain response and would make people more sensitive to alcohol.
    Probably one of the best examples is a gene called aldehyde dehydrogenase 2. Variations of this gene are common in Japan, with some research indicating they can be found in almost 50% of the population. In people with these gene variations, a glass of wine causes such an uncomfortable physiological effect that they do not want to drink. Their cheeks flush, their heart pounds and they feel sick. One of the oldest antidotes to alcoholism is Antabuse, which works on the ALDH2 gene. "Half the population of Japan is in a natural Antabuse state," said Dr. David Goldman, a leading alcoholism researcher at the National Institute of Mental Health.
    Goldman and his colleagues have spent years combing through the genes of populations at risk for alcoholism and identifying risk genes. Each gene identified--about a dozen--has a different effect on the brain and behavior, Goldman said. These days, his sights are set on a gene called COMT that is turned on in the brain's frontal lobes and is thought to play an important role in impulse control and cognitive function. Goldman is also focusing on genes that regulate serotonin, an important brain chemical that governs many aspects of behavior and emotion. Genes that regulate the brain chemical dopamine and endorphins also have been implicated in alcoholism and drug addiction. Dopamine pathways are active in reward and reinforcement; endorphins are brain chemicals that trigger the feeling of pleasure and reward.
Dr. John Numberger Jr. and his colleagues at the Institute of Psychiatric Research at Indiana University Medical Center identified a strong link on Chromosome 1 that affects both alcoholism and depression. They are still searching for the specific gene or genes involved.
    Goldman has spent years with Southwest American Indian tribes and isolated several genes that he believes put them at great risk for alcoholism. Goldman found that the genetic contribution might be as high as 85% in males in some of the tribes he has studied. "People are not just making lifestyle choices, or hereditability wouldn't be so high," Goldman said. "I don't know why people have a problem calling [alcoholism] a disease. Clogged arteries exist because of choices made about eating Twinkies. No one says it isn't heart disease."
    The brains of alcoholics are different, and studies are beginning to address what this may mean for diagnosis, prevention and treatment. In a new study, published in the Archives of General Psychiatry, Dr. Mark S. George and his colleagues had 10 alcoholics and 10 social drinkers take a sip of alcohol while hooked up to monitors to measure brain activity. After tasting the alcohol, they were shown pictures of alcoholic and nonalcoholic beverages. Only the alcoholics showed increased activity in the prefrontal cortex and anterior thalamus when looking at pictures of alcohol. These brain areas are involved with emotion, attention and appetite. The control subjects had increased activity in different brain regions.
    Federal scientists are also finding distinct gender-related differences among alcoholics. Dr. Daniel Homer of the national alcohol institute took brain scans of men and women, all heavy drinkers, and found that women had greater decreases in the size of a portion of the brain than did men--even though the two groups drank a comparable amount.
Alcohol works on some of the same biochemical pathways involved in the stress response. In particular, a hormone called ACTH is released during the stress response. Small amounts of alcohol also trigger the release of ACTH. Many scientists and drug companies have been trying to find compounds similar to ACTH that could be used to design new treatments.
    Laboratory animals behave quite like humans when it comes to alcohol consumption and stress. If 20 male rats are put in cages with two drinking tubes, one with saccharin, the other with saccharin and 10% alcohol, 20% of the rats will never drink the alcohol; another 20% will drink significant amounts; and still another 20% will consume the equivalent of a social drinker. But if these same animals are exposed to random bouts of stress, after a week they will all drink more.
    Federal researchers studying the effects of early maternal separation have shown that monkeys brought up away from their mothers had twice the level of stress hormones in their blood than monkeys that were not separated from their mothers. When these same animals grew up and were given free access to alcohol, the animals that were separated at birth consumed much more than their less stressed counterparts. "Both drinking behavior and an individual's response to stress are determined by multiple genetic and environmental factors," Gordis said. "If borne out in humans, these findings elucidate the alcohol-stress relationship in two ways: They confirm that early life stress can influence later alcohol consumption, and they offer a promising biological marker of risk for excessive drinking."
    Figuring out alcohol addiction seems an insurmountable task, as some studies are quick to show. In one recent experiment, genetically identical animals were distributed to labs in Albany, N.Y., Portland, Ore., and Edmonton, Canada, and those who handled the animals were trained to do so in a particular way. But it turned out that those who were fed alcohol behaved differently from those who were able to take it themselves. Different genes were turned on. Those fed alcohol drank more, at first. The animals given the choice--the freedom--to drink ended up drinking more. "How the alcohol is administered has a profound effect on the results," Gordis said. "We have to pay attention to these issues."
    Unfortunately, the complexities inherent in the disease process have made finding effective treatments difficult. The federal alcohol research institute has recently embarked on a study to test a combination of treatments for alcoholism. During the next two years, doctors at 11 treatment centers will enroll more than 1,300 people, who will receive one or both of two behavioral therapies and one or both of two medications (naltrexone or acamprosate) or a placebo. They will also have outpatient therapy sessions for four months and return for follow-up. "As many as 50% of those who receive treatment for alcoholism relapse at least once, and only a fraction achieve long-term remission of the disease," said Dr. Roger Weiss, director of McLean Hospital's alcohol and drug treatment center in Massachusetts and one of the investigators in the federally sponsored trial. "The clinical trial may lead to better treatment."
    Many doctors are dissatisfied with current treatments. Dr. Charles O'Brien, an expert on alcohol addiction at the University of Pennsylvania, has observed for 30 years how the treatment for addictions has changed, but remains unimpressed. He and other alcohol-abuse experts say that alcoholism is a chronic disease and that long-term treatments will be necessary to help people avoid drinking throughout their lives.

Current Research on the Cause of Homosexuality
Melissa Healey, Los Angeles Times- 5/26/2001

It is not the most cherished childhood photo in his mother's collection, but it may be the most prescient. The little boy, not quite 2, is perched on a potty seat. A mop of brown hair frames a face with delicate features and big brown eyes. He is wearing a pretty white sundress purloined from his older sister's closet, a "very girly" frock, according to his mother, that is one of his two favorites. Secreted away elsewhere in the house are the little boy's other passions: his mother's fancy shoes and jewelry, his sister's Barbie doll. And behind the lens is mom, a college professor from Toronto, "collecting evidence" that she can take to the pediatrician.
    The boy in the photo, now nearly 15, is contemplating his sexual orientation with the same secretiveness that he once used to hide his penchant for cross-dressing. On the phone, he gabs with his many girlfriends about their current crushes, adopting their incredulous, eye-rolling gestures and their distinctive, sing-song mode of speech. About his own crushes, however, he is mum.  His mother, who demanded anonymity in the interests of her son's privacy, has no doubt about the young man's future sexual orientation. "I'm sure he'll end up being gay," she says matter-of-factly. As a parent, she wishes it were otherwise; being straight is simply an easier life for a young adult, she said. But she loves her son, and it's clear to her that even before she and her husband adopted him 20 days after the child's birth, this, simply, was the way he was made.
    While scientists have pondered the mystery of homosexuality for centuries, the secret of how homosexuals are made is only now beginning to yield to their inquiries. Long branded a mental illness, attraction to those of the same sex was expunged in 1973 from the list of psychiatric disorders recognized by practicing clinicians. And American society has fitfully followed suit, emboldening many in this long-closeted minority to declare and celebrate their sexual orientation openly.
    The drive toward societal acceptance has not dampened many scientists' zeal to explain one of evolution's most curious mysteries: Why has a trait that inhibits sexual reproduction endured? To these researchers, homosexuality remains an evolutionary oddity that demands to be explained. Intriguing new research is finding there may be many different pathways to gayness. Those seeking to explain homosexuality traditionally looked for instances of early sexual abuse, emotionally distant parents and other socialization factors to explain a child's later same-sex attraction.
    But researchers from unexpected disciplines such as brain science and audiology are bringing new perspectives to a field long dominated by Freudians, social workers and, more recently, by gay activists. They are uncovering a wide range of possible physical markers for homosexuality--from the way one's inner ear responds to sound to the shape of one's hand--that are evident from a child's first days. These insights not only point to the mechanisms at work in homosexuality: They offer the intriguing and controversial prospect that perhaps in the not-too-distant future, parents like the mother in Toronto could do more than brace for a child's sexual awakening; they could do something about it.
    Still, the science of homosexuality remains in its infancy. For now, there exists only one childhood trait--often exhibited before a child can walk--that strongly predicts homosexuality later in life. It is early behavior that departs markedly and persistently from the boys-and-trucks, girls-and-dolls stereotypes of years past. For the cross-dressing toddler in Toronto and other boys who show "pervasive and persistently" effeminate behavior, the odds of being gay lie at about 75%, according to J. Michael Bailey, a psychologist and sexuality researcher at Northwestern University in Evanston, Ill. That is a probability of homosexuality 20 times as high as that in the broad population of boys; it is estimated (though hotly disputed) that 3% to 4% of males will grow up to be gay. Among girls, this so-called gender-atypical behavior also is a good predictor of later lesbianism, though the pattern is weaker. That may disappoint those who hoped science would have disproved a painful stereotype. But strong and sustained gender-crossing behavior is, says Bailey, "about as strong a predictor as exists in the developmental literature."
    Strong as the relationship may be, however, it has major limitations. Most important, researchers stress there is no evidence that early gender-bending behavior is the cause of later homosexuality: In fact, many argue, the early onset of such predictive behavior suggests that for many, sexual orientation may be fixed at birth. The fact that such behavior is more likely to be greeted with horror than encouragement by family and friends is seen as further evidence for that position. Beyond that, researchers caution, such behavior is far from conclusive. Many adult gay men and lesbians were gender-conformers as children. And many boys derided as "sissies" and girls labeled as tomboys grow up to be straight.

Consistently Fighting Traditional Roles
The distinction, say researchers, is gender-bending behavior that is neither subtle nor temporary. It isn't "just a phase," say parents like Angela and James, a couple who spoke on condition their last names not be used.  By the time he was 18 months old, their son, now almost 7, was drawn to his mother's shoes and scarves. From 3 years old, he "'would obsess" about the Little Mermaid and Cinderella, mimicking their dresses, their songs and their gestures, according to his parents. "Being the progressive, modern-thinking parents we were, we thought, 'Let's not stereotype,' " said Angela, explaining why the couple bought their son a Barbie doll (and a Ken, whom the child pointedly ignored) when he asked for it.
    It was a poignant moment of epiphany--the day their then-4-year-old son stood up in a shopping cart and wept at the realization that he would not grow up to be a mommy--that drove the couple to seek treatment for the child's "gender-identity disorder." A certain type of treatment, called "reparative" or "conversion" therapy, seeks to steer a gay person toward heterosexual behavior. By contrast, however, treatment for gender-identity disorder focuses on an individual's confused sense of self, seeking to make them comfortable with their actual gender.
    The American Psychiatric Association continues to view it as a mental disorder. But because it affects many in the homosexual community, gay activists object sharply to the labeling and treatment of what they call "transgender" behavior, denouncing clinicians' efforts as "genocide." All of which underscores a key point: As a field of research, homosexuality lies at the dangerous intersection of science and minority politics. In this world, every new finding carries added weight. Both gay activists and their detractors--largely Christian conservatives who view homosexuality as contrary to biblical teachings--dissect the work of researchers for political meaning. If gays and lesbians are "born that way"--if homosexuality can definitively be traced to genes or prenatal environment--is being gay a choice? Do lesbians and gay men follow the same pathways to homosexuality? And if scientists can uncover how homosexuals are made, will they not be an important step closer to finding how they can be unmade?
    To homosexuals struggling to protect and extend their rights, the answers to these questions may mean the difference between acceptance and intolerance, cultural vibrancy and decline--life and death, even. For even as a majority of Americans tell pollsters they believe homosexuals should enjoy job protections and basic human rights, roughly half of Americans, according to the Gallup Poll, continue to believe homosexuality "should not be considered an acceptable alternative lifestyle." And only 29% say they would like to see homosexuality "more accepted" in this nation.

Worry for a Child's Status in Society
For parents in particular, the dilemma of anticipating a child's homosexuality can be acute. The Toronto mom, whose son started playing with her fancy shoes at about 10 months, is typical: Like many who see the early glimmerings of a child who will grow up to be gay, she insists that as an intellectual, ethical and political matter, she would never consider trying to change her son's sexual course. But as she assesses the social challenges a gay son will face in life, she echoes the sentiment of virtually all parents interviewed for this article: If her child could magically be remade, she would wish a heterosexual life for him. "It's tougher to be a gay kid in high school," said James, whose 7-year-old has been treated for gender-identity disorder. "Geez, it's not easy being a straight adolescent!"
    Although hypothetical for today's parents, the possibility that future parents may be able to take a pill or tinker with a gene to steer their offspring toward heterosexuality is no pipe dream. "It's not a matter of whether" we'll find homosexuality's basic mechanisms, "it's a matter of when," said Dennis McFadden, a University of Texas specialist on auditory perception. "And parents are going to rush to influence them, possibly before a child is born."
    Indeed, scientists are finding that an individual's sexual orientation may be most powerfully shaped before birth--both by genes and, as more recent research is showing, by prenatal environment. In the last two decades, researchers have established beyond much doubt that, like high intelligence, green eyes or a propensity for certain diseases, homosexuality runs in some people's genes. Northwestern's J. Michael Bailey, who has conducted much of this research, notes that a male with a gay brother is three to seven times more likely to be gay himself; and a woman with a gay sister is four to eight times likelier to be a lesbian than a female drawn from the broader population. "The data definitely are not as strong as for other traits such as intelligence or schizophrenia," said Bailey. But he added that researchers from various disciplines are nearing consensus on this point: Some genetic component to homosexuality clearly exists.
    Studies of identical twins--siblings with the same DNA--illustrate both the power and the limitations of genes in homosexuality. A man or a woman is at least 10 times likelier to be gay if his or her identical twin is homosexual; in other words, his or her probability of being homosexual lies between 20% and 50%. But flip that figure over, and it looks far less impressive: Those probabilities still mean that, among identical twins in which one is homosexual, between half and 80% have a heterosexual twin. Having a "gay gene," if such a thing exists, carries no certainty of being gay.
    How else, then, to account for homosexuality? In the last several years, a welter of new research has begun to point strongly to a developing fetus' intrauterine environment as a possible incubator of gayness. This new line of research has been scattered broadly across the peer-reviewed journals that collectively make up science's bazaar of evidence and ideas. But it all started with a little-understood birth-order peculiarity long observed among adult gay men: They tended to be little brothers, frequently in a household full of older boys.
    "When I first encountered these early studies, I thought they were so preposterous that I dismissed them out of hand," said Ray Blanchard, a psychologist at the University of Toronto's Department of Psychiatry. "It struck me as the most bizarre example of pseudoscience." Later, "by accident," Blanchard said, he happened upon evidence in his work that there might be something to this anecdotal oddity. He began scouring dozens of databases containing data on both birth order and sexual orientation. By the late 1990s, he had established one of the strongest associations with homosexuality in the field. For a male child, Blanchard found, the more older brothers in his family, the higher the probability that he would be gay. A firstborn male has a likelihood of homosexuality of about 2%. But for a boy with four older brothers, those odds jump to 6%, Blanchard found. In all, he estimated, one in seven gay men owed his sexual orientation to this "fraternal birth order" effect.

An Immune Response That May Grow Stronger
What force was at work here? An intriguing parallel suggested an explanation. "Blue babies," or babies born with anemia due to incompatibilities with their mother's blood type, were much more likely to be latter-born males, too. And researchers had established that the "blue baby" effect was the result of a maternal immune reaction to the presence of foreign cells--male cells--in her blood during pregnancy. With each male child a woman carries, that immune reaction grows stronger and so does the probability of a maternal reaction to the blood incompatibility that causes a newborn to look blue from low oxygen.
    Blanchard hypothesized that a pregnant woman carrying a male child has an analogous kind of immune response, which grows stronger with each subsequent male fetus she carries. While he is unclear how, exactly, that immune response affects the baby, many researchers coming to the same conclusion surmise that it affects the chemistry of the amniotic soup in which a fetus develops. At a crucial period of fetal brain development, a higher-than average concentration of certain hormones--say, the powerful hormone estradiol--could cause changes in the way the developing baby's brain is wired. The implications of that chemical shift would likely be evident early. And they would likely last a lifetime.
    By the end of the 1990s, other researchers were beginning to posit similar hypotheses on the bases of wildly different data. Researchers already had established that compared with their heterosexual counterparts, gay men and lesbians were more likely to be left-handed. But in Berkeley and in Liverpool, England, a psychologist and a biologist, working independently, were finding that the shape of the hands--a key measure of in-utero exposure to sex hormones--tended to be different too. Simply put, the ring finger of a heterosexual man's right hand tends to be much longer than his index finger; in straight women, the two fingers typically appear nearly the same length, with the pointer dipping just slightly below the ring finger. But John T. Manning, a biologist at the University of Liverpool, found that as a group, lesbians have a hand pattern that looks more like a man's than like that of a typical straight female, though still not quite as pronounced. "The finding, Manning concluded, "strongly tells us that female homosexuals have had high levels of exposure to testosterone before birth."

Texas Researcher Takes Another Tack
Manning seemed to be zeroing in on a defining moment in the development of sexual orientation. In the meantime, in Austin, Texas, a very different route brought psychologist Dennis McFadden to the same conclusion. A psycho-acoustics specialist, McFadden has studied group differences in two measures of hearing: otoacoustic emissions--tiny clicking sounds produced by the auditory system in response to stimulus--and auditory-evoked potential, the brain-wave peaks that an individual produces when presented with sound. From their earliest days, boys and girls score differently on each measure--no surprise, perhaps, since a fetus' auditory system develops at the same time that hormonal differences peak in the womb and gender differences emerge. But McFadden found that lesbians fell between heterosexual men and women on both measures--a strong sign that they were exposed to higher-than-normal levels of male hormone in utero.
    But like Manning in Liverpool and University of California psychologist Marc Breedlove, McFadden turned up a confounding pattern when he tested gay males. In one auditory measure, but not both, homosexual men were "hypermasculinized" compared with heterosexual men: Essentially, their brain wave peaks produced in response to sound were more "manly" than those of the average straight man. Breedlove, surveying hand shapes with a portable photocopy machine at a San Francisco street fair, had come up with a similar finding. Writing in the journal Nature last year, Breedlove reported that he had been unable to establish a direct relationship between the overall average finger lengths of men and their sexual orientation. But on the basis of their finger lengths, he found that some gay men appeared to have been exposed to greater-than-normal levels of male hormones prenatally.  McFadden and Breedlove had run headlong into one of homosexuality's most entrenched stereotypes and some of its strongest research. In many cognitive measures, gay men tend to fall between men and women on the continuum of gender differences--they are, according to researchers, "feminized." Gay men tend to have better language skills, an area where girls generally fare better than boys. And they tend to be weaker in activities that take great spatial acuity, like maze-running and mathematics--areas where boys, as a group, outperform girls.
    But here, by contrast, was evidence that some gay men were more "male" than the average male. And it tracked with other, sketchy indications of "hypermasculinization" among a group of male homosexuals: Their average number of sex partners was greater than that of their straight counterparts, the levels of testosterone that circulated in their blood was higher and their genitalia were larger. "This calls into question all of our cultural assumptions that gay men are feminine," said Breedlove. Evidence like this has confounded and unsettled the community of researchers as well. With new findings scattered across many disciplines and, at best, a patchwork of explanations for homosexuality emerging, little is settled in this most incendiary of fields.
    Within the gay activist community, the jumbled state of research is greeted with conflicting reactions: There is fascination "because these studies help us understand who we are," said David Smith, a spokesman for the Human Rights Campaign, a Washington-based gay-rights group. And there is a kind of grudging sympathy for the challenges facing researchers, since gay men and lesbians know how complicated and diverse they are. And finally, Smith added, there is a sense that whatever the outcome of research, "it shouldn't matter, because everyone deserves to be treated with dignity and respect."
    Indeed, the fact that no one researcher has unlocked the mystery of all homosexuals' orientation suggests there may be many different factors at work. Gay men and lesbians, in short, come in all varieties, scattered widely across our conventional notions of masculinity and femininity, said Northwestern's Bailey. "That suggests possibly that there are different bases for homosexuality" in different people, he said. If they are to continue to uncover homosexuality's roots, scientists acknowledge, they increasingly will have to look at gay men and lesbians not just as groups, but as individuals. In that sense, they say, they are mirroring the challenges of the larger society. And the sentiments of parents like Angela and James.
    "It's not on my mind that I'm watching our son grow up gay," said James. His 7-year-old is, he added, simply who he is: a shy child with a backyard fort and, yes, an attraction to Barbie dolls. If he ends up being gay, they will not worry so much about whether it was the fraternal birth order effect or an infancy traumatized by premature birth and kidney problems. "If he decides he wants to come out," said Angela, "I'll simply be the biggest advocate out there."

Woman Wins Suit Against Hypnotist
Chicago Tribune, 5/27/2001

LONDON, ENGLAND -- A woman who said a stage hypnotist turned her into a "zombie" has won a $9,000 judgment. Lynn Howarth had told London's High Court that her problems began when she was hypnotized by Philip Green at a social club in northwestern England in 1994. "I went to that stage show as a normal, happy, healthy, energetic woman and came out a zombie," she told the court.
    Howarth, 40, said an age-regression skit in Green's act reawakened memories of sexual abuse by an uncle when she was 8. Panic attacks and depression ensued, and twice she attempted suicide. "It was like the worst possible hangover magnified 100 times, a continuous throbbing sensation, and it was there for months and months," Howarth said. Judge Brian Leveson agreed that Green's suggestion caused Howarth "to regress to an age when she was sexually abused and, as a result, suffer depressive illness."