Noteworthy News Articles on Mental Health Topics, June 5-9, 2001

Some Psychotherapists Embrace Online Therapy, Despite the Handicaps
Snow Anderson, Chicago Tribune- 6/5/2001

Imagine sitting in the comfort of your own home and having a face-to-face counseling session with a therapist. No, psychologists are not starting to make house calls; this scenario requires a computer, a Web cam and high-speed Internet access. It's yet another marriage of health care and high tech, but like so many other dot-com businesses, the theory behind video counseling may have been better than the reality.
    It's difficult to gauge how many such Web sites exist, but one of the more prominent ones is videoShrink.com. It was set up in June 2000 by three clinical psychologists who work and practice together in Santa Clarita, Calif. "We went to great lengths to ensure we were meeting the legal and ethical standards of our profession," said Illinois native Lynne Steinman, one of the founders of videoShrink.com. A self-professed "cold-weather wimp," Steinman fled the Midwest for the kinder and gentler temperatures of California shortly after her graduation from the University of Illinois in 1974. She has been in private practice for more than 20 years.
    In setting up their Web site, Steinman said she and her partners consulted with several attorneys and ethicists, who are also psychologists, and the American Psychological Association. "We are perhaps less commercially driven [than other similar Web sites], but we pride ourselves in having set high standards," Steinman said.
    Their site lists the issues they believe are most amenable to video therapy: self-esteem, relationships, workplace problems, parenting, depression, stress and anxiety. The cost is comparable to traditional office visits: $85 to $120 for a 45-minute session. The site also explains that they are neither able to provide emergency services between sessions nor work with clients who are violent or suicidal. videoShrink.com also requires an informed-consent form before any of its nine therapists agrees to provide treatment.
    "It's a little bit different [from standard counseling]," Steinman said. "Even though we get a visual, we get the non-verbal, there's still a feeling you have when you're in the room with someone that you don't quite have with this. But it is the next best thing." Steinman acknowledged that the quality of the image is still far from perfect. "The image is pretty good," she said, "but there is a bit of delay between image and voice. It takes a few minutes to get used to. At least one positive aspect," she added half-jokingly, "is that, as a therapist, you interrupt less, because you're waiting for the complete answer."
    When it comes to video counseling, or any kind of Internet counseling for that matter, caution is advised. A licensed psychologist in San Diego, Calif., Marlene Maheu thinks there is a risk both for the practitioner and the patient. "We are trained to diagnose auditory and visual clues," she said, "and if we don't have the opportunity to see that, we cannot offer the same standard of care. Anybody can set up a Web site," she said. "Are patients protected? No. Are they flocking to these sites? No."
    Maheu, who has been operating an online mental health magazine since 1994 (selfhelpmagazine.com) has studied the field of telehealth extensively. Her involvement has been primarily through video conferencing, which provides a far clearer image than that generated by a Web cam. The application of video technology is useful, Maheu explained, in cases where people may be geographically or physically limited in access to a therapist. "It's better than driving 200 miles in the middle of winter in Idaho," she said, but Maheu holds firmly that video counseling should be used only after personal contact has been established.
    Maheu is especially concerned about the lack of security inherent in Internet counseling. "We're working with a population that's sensitive and vulnerable. Web sites can be secured, but with e-mail, it's like a party phone line--it knocks on many doors before one of them opens. That's why public e-mail is not safe," Maheu said. In order to really make video counseling safe on the Internet and "prevent the average hacker from getting on," Maheu said, the connection would have to be encrypted, but the level of encryption required would significantly slow down the transmission time between sound and movement. The technology needs to be developed a lot more, she said, in order for it to transmit the clear image required in counseling situations.
    On the issue of safety, Steinman is frank. "The people who set this up for us at Microsoft have assured us that there is no way to hack into or interrupt a session. That's what we're told, but people have abilities to hack into things, of course they do. In our case, though, there are no files that are archived; it's like a phone call. But people can hack into that as well. We use the best due diligence we can."
    People from as far away as Israel and Australia have responded to their site, Steinman said, but the overall response has not matched their expectations. "It's been slower than we had hoped, but the whole dot-com [industry] is still in an uproar. Even the huge health Web sites are having problems."
    Chicago psychologist Lisa Grossman is not surprised that the video-counseling industry hasn't boomed. "It's still in its infancy," she said, and she is not aware of anyone offering video counseling in the Midwest. One of the main reasons is licensing issues. "I'm licensed in Illinois, but if my patient is in California, which laws do I abide by? That's not clear," she said, "and the courts have gone both ways." If, for example, the patient sues, where is the jurisdiction, she asked, and what happens in cases of emergency? "Those kinds of wrinkles haven't been ironed out yet," she said. Grossman, who is on an American Psychological Association task force on telehealth as well as a national advisory committee to establish guidelines for health care Web sites, believes there are real advantages in using Internet technology in the field of health, and it will happen more and more. But being able to send an X-ray over the Internet, she said, is a far more practical and prevalent use of the technology right now than video counseling.
    Steinman and her colleagues are undeterred by the less than enthusiastic reception of their high-tech counseling offering. "Our goal is to hang in there; the video-conferencing technology will be improved in a couple of years, and more people will have more access to high-speed lines."

Virginia Anti-Bully Program Receives Attention
Sandra G. Boodman, Washington Post- 6/5/2001

Counselor Marilyn Towsey reviewed techniques the sixth-grader could employ when classmates call her fat, tell her she smells, impugn her family or shun her. In a calm, deliberate voice, the counselor ticked off the strategies dramatized in the 20-minute video she and the girl had just finished watching: The sixth-grader could walk away, ignore her tormentors, slip a note to a teacher or look for allies among her classmates. Visibly distracted, the 13-year-old started spinning in her swivel chair, which edged precariously close to Towsey. "I just want to know why they make fun of me when I don't make fun of them!" the girl blurted, her face inches from the counselor's, her voice ricocheting off the painted cinder-block walls of Towsey's office. "Well, that's an age-old question," Towsey replied, deftly steering the conversation to the subject of "boundaries" -- a concept the girl's in-your-face behavior indicated she didn't grasp.
    A few years ago this counseling session would have been unimaginable at Liberty Middle School in Ashland, Va. -- or at virtually any other American school, for that matter. That was before the administration at this time-worn, red brick school, located in the middle of farmland 15 miles north of Richmond, declared war on bullying behavior. Last year Liberty, which has a racially and economically diverse student body, became one of five schools in the United States to receive a Justice Department grant to test a promising anti-bullying program that has had considerable success in Norway and other Western European countries.

The goal of the two-year program
Known as Blueprints, which is administered by the University of Colorado at Boulder, is ambitious: to reduce bullying by changing the culture of a school, making it clear that such harassment will not be tolerated and that adults will actively intervene to stop it. And while some programs put the onus on kids to "work it out," Blueprints enlists the entire school community: parents, teachers, coaches, staff from the principal to bus drivers as well as all students, not just bullies and their victims. It features a locally designed curriculum and emphasizes vigilance by teachers and other adults, who are taught to respond quickly rather than tolerating or ignoring the behavior, as is typically the case.
    Officials at Liberty say they don't believe that bullying -- persistent, negative psychological or physical acts directed by a stronger student or group against a weaker one -- was worse at their school than elsewhere. A survey conducted before Blueprints was launched found that 29 percent of students said they had been bullied at school in the preceding month. A recent survey of 15,000 U.S. students conducted by researchers at the National Institutes of Health found that about 30 percent reported they recently had been perpetrators or victims or both. "I think our problem was kind of typical," said Catherine F. Moffett, the veteran guidance counselor who persuaded the Hanover County School Board and Liberty's principal, Robert Wingfield, to let her apply for a $5,000 federal grant to implement the program.
    The anti-bullying ethos now pervades life at Liberty, which houses 1,200 sixth, seventh, and eighth-graders -- 400 more than it was built to hold in 1970. Posters adorn the scuffed hallways, and special "BINT" forms -- short for Bullying Is Not Tolerated -- hang in folders accessible to students and staff who are encouraged to report incidents they witness. First period every Thursday consists of "Character Education" -- 45 minutes of informal discussions that focus squarely on bullying or related topics, such as trust and relationships. These sessions are designed to make all students feel they can confide in a sympathetic adult who will respond to their problem.
    At the suggestion of students, Liberty even held a "bullying drill" -- modeled after fire and tornado drills -- to see how long it took teachers to respond to a simulated incident. "It gave us good information on what areas of the school are harder to monitor," said Wingfield, noting that supervision in out-of-the-way corners, where bullying is more likely to occur, was intensified as a result.
    "Sometimes you think, 'If I hear the word bullying one more time I'm going to scream,' " the principal acknowledged, echoing a sentiment he said was not uncommon among his staff. "But then you hear about shootings like the one in California," he said, referring to the incident last March at Santana High School in which two students were fatally shot by a 15-year-old classmate who had been relentlessly tormented. "The thing is," Wingfield added, "Columbine changed everything."

The Legacy of Columbine
The shootings at Columbine High School in Littleton, Colo., in April 1999 were a turning point for the nascent anti-bullying movement in American schools. Columbine was the event that made educators realize it could be dangerous to ignore a problem that officials in other countries, most notably Norway, had been actively targeting for two decades. The murderous rampage by two trenchcoat-wearing outcasts -- who had been ceaselessly bullied by popular jocks whose harassment was tolerated by school administrators -- wasn't the first case of a bullying-related school shooting. But it grabbed public attention in a way other incidents had not.
    Before the avalanche of publicity that followed Columbine, bullying had been regarded as little more than a footnote to school violence prevention programs, which focused mostly on drugs, weapons and gangs. "Six or seven years ago, bullying prevention programs were a really hard sell," said Susan P. Limber, a psychologist with Clemson University's Institute on Family and Neighborhood Life and consultant to the Blueprints program. That's because until the past decade or so, bullying was regarded as an inevitable, if unfortunate, rite of passage. "For the longest time we just thought this was a normal part of growing up," said Dorothy Espelage, a research psychologist at University of Illinois at Champaign-Urbana who has published nearly a dozen studies of bullying.
    Since Columbine, the traditional, benign view of bullying -- which has been seen in virtually all cultures, among both sexes, in ramshackle one-room schoolhouses, teeming urban middle schools and elite prep schools -- has been supplanted by a recognition that the behavior can have lasting, even devastating, consequences for the bullied and for bullies. But reducing bullying means confronting deeply ingrained cultural expectations. "I really think a lot of people believe that bullying toughens kids and that if they learn to handle it they'll be better competitors," said Kevin Dwyer, former president of the National Association of School Psychologists. There's no evidence that this is true, Dwyer noted, and plenty to suggest that bullying can inflict serious psychological harm.
    Every day, according to the school psychologists association, 160,000 American youths skip school fearing they will be the targets of bullies. Studies have found that children identified as bullies or as victims at age 8 were still identified as such at 16, and both groups had more emotional problems than other students. Bullied students have higher rates of depression, which persist into adulthood. Sixty percent of boys identified as bullies in middle school had at least one criminal conviction by age 24, while 40 percent had three or more convictions.
    Although few students who are bullied take a gun to school and kill their classmates, a recent study funded by the U.S. Secret Service found that two-thirds of the 41 youths involved in school shootings since 1974 said they had been bullied at school and that revenge was one of their motives. In a number of cases, the Secret Service study noted, "attackers described experiences of being bullied in terms that approached torment . . . of [being the victims of] behaviors that, if they occurred in the workplace, would meet the legal definitions of harassment."
    Two of the most recent school shootings certainly fit that pattern. Charles Andrew Williams, 15, who is charged with killing two classmates March 5 at Santana High School in Santee, Calif., was incessantly ridiculed by bigger classmates who called him "faggot" and pressed their hot metal cigarette lighters against his neck. Two days later and 3,000 miles away in Williamsport, Pa., 14-year-old Elizabeth Catherine Bush shot in the shoulder a classmate she identified as her chief tormentor, the 13-year-old cheerleading co-captain, during lunch period at Bishop Neumann High School. Bush's parents had transferred her to the small Catholic school after she had been literally stoned by classmates at a public school who barked when they saw her.

Norwegian Approach
Although bullying has been grist for fiction and memoir for generations, it wasn't taken seriously by most research psychologists until the 1980s, when a national tragedy unfolded in Norway. In 1982 three young boys, all victims of severe bullying at school, committed suicide within a few months of each other in different parts of the country. The deaths galvanized Norway; one of the results of the national soul-searching was a commitment to end, or at least reduce, bullying in Norwegian schools. Out of that came a series of studies and a comprehensive program devised by Dan Olweus, a professor of psychology at the University of Bergen. Olweus's anti-bullying program, which has been replicated in other countries, remains the model for many efforts around the world, including Blueprints.
    In the 1990s, when Justice Department officials were searching for programs that reduced school violence, they became interested in Olweus's approach -- which achieved a 50 percent reduction in bullying in Norway over a period of several years, as well as unexpected and dramatic declines in truan\cy, vandalism and other problems. "It's embarrassing how far behind the U.S. is," said Illinois' Espelage, who like most researchers believes bullying behavior can be reduced but not eliminated. "The reality is that what we study is what's being funded."
    While a growing number of schools are cracking down on bullying, researchers worry that many are turning to dubious and untested approaches or harsh zero-tolerance policies that are more punitive than educational. "Bullying is suddenly hot, and consultants are coming out of the woodwork," said Nancy Mullin-Rindler, director of the Project on Teasing and Bullying at Wellesley College in Massachusetts and project director for the Massachusetts anti-bullying program, modeled after Olweus's. "Dealing with bullying is like dealing with all kinds of behavior," she added. "It's complicated and it has to be sustained over time, and that's a very hard thing for schools to do. It's not a matter of putting slogans around the school or holding a quickie assembly that says, 'We care.' "
    Even the Olweus approach has undergone little independent evaluation in the United States, and some experts, Espelage among them, question whether a program developed in Norway will be effective in this country. The results of a pilot test conducted several years ago in rural South Carolina have not yet been published. Limber, the project director, said that there was 20 percent less bullying in middle schools that adopted the program, but that those reductions were not sustained over time, as they were in Norway. One of the biggest obstacles to reducing bullying may be the commitment required of a school in an era when teachers are being pressured to concentrate on standardized tests. "Teachers sometimes look at this as one more thing they have to do," Mullin-Rindler noted.
    At Liberty, many, but not all, teachers say they are committed to carrying out the program, which emphasizes re-education over punishment. One of the cornerstones of the experiment is teaching bystanders, who are often fearful of becoming targets themselves, to become involved, either by speaking up in defense of the victim, enlisting the aid of an adult or refusing to participate in rumor-spreading. "If there's no one to listen, you can't spread a rumor," Marilyn Towsey told a sixth-grade class recently. "And one of the major things that cause conflict in schools is rumor." Bullying infractions at Liberty are met with a graduated series of sanctions: The first offense results in a note in a student's file and a warning that teachers will be watching closely for recurrences. After a second infraction a student must sign a behavioral contract pledging not to bully others. The third offense requires parental notification and individual "re-education" counseling. School officials say this has happened only once.

Fistfights Drop, Bullying Persists
There are signs the program is having an impact at Liberty. Since its inception a year ago, fistfights have declined 90 percent, according to Wingfield. But he acknowledged that bullying remains a problem. "The subtle interactions are always going to be more difficult to monitor," said the principal, an enthusiastic supporter of the program.
    While teachers are trained not to ignore bullying, they are also expected to reward exemplary behavior in the hope of fostering more. Students who are "caught doing good" -- such as standing up for a victim or being kind to an unpopular classmate -- receive praise in the form of blue cards, and a laudatory note is sent home to their parents. Sixth-grade teacher Terry Williams said she recently bestowed blue cards on three girls who invited a boy who frequently is ostracized to join their work group.
    Liberty students say they believe the program has reduced bullying, but that harassment persists because some teachers continue to tolerate it. "I think guys are almost expected to bully each other," said Edmund Massie, an engaging eighth-grader who said he has been harassed because he is short and because he excels academically. His father, he noted, had advised him to fight back and "take the guy out" -- advice Massie ignored. Massie's mother is supportive of the program and said she believes it has improved the atmosphere at the middle school her two older daughters also attended. "The teachers and administration have really bought into this," Ellen Massie said. "I feel like I could go in there and get something done. We don't just have to sit back and say, 'Well, that's the way kids are.' "
    But the challenge for anti-bullying programs is helping kids who just don't get it, students who seem impervious to the messages and techniques that are the subject of assemblies and drama workshops and discussion groups. Take the sixth-grader with whom Towsey has spent months working. She exemplifies a small group of victims who are known as provocative rather than passive. She screams at other kids or invades their space or talks too loudly; sometimes she smells. Her peers alternate between avoiding her and taunting her; many of her teachers also find her irritating. When someone says something mean to her, she lashes out verbally and sometimes physically; she was referred for individual counseling after smacking a boy who insulted her father. Her home life is chaotic, according to school officials, and the girl said she takes a high dose of Ritalin to treat a severe case of attention deficit hyperactivity disorder. While she enjoys the attention of the program's individual counseling, she seems oblivious to basic social norms and the effect her behavior has on other people. She can parrot the lessons of bullying workshops, but she can't implement them. "She can't read social cues, she isn't doing well academically, she's big for her age and she has few friends," Towsey observed. "It's been a tough thing, trying to figure out a solution."

Resources
Several Web sites contain information about bullying, including tips for coping, descriptions of school-based programs and suggested reading for kids and adults.
• The National Parent-Teacher Association: www.pta.org/programs/sycsch.htm
• The Committee for Children, a Seattle-based group that sponsors Steps to Respect, a bully prevention program: www.cfchildren.org/PUbully.html
The Blueprints Bullying Prevention Program, which Liberty Middle School is using: www.colorado.edu/cspv/blueprints/model/ten_bully.htm

Drug War Shifts to a New Front
Will Kangas, Jackson Citizen Patriot- 6/5/2001

A recent bust by Michigan State Police of a burglary ring that spanned southern Michigan and northern Indiana and Ohio not only revealed the theft of $40,000 in goods but also confirmed something area drug enforcement agents had feared. Ketamine, or "Special K," is trickling into Jackson County after quickly becoming a fashionable club-scene drug in other parts of the country.  While ecstasy remains the most-publicized drug of the young, it still has to be manufactured outside the country and brought in.  Ketamine has grass-roots accessibility--veterinarians use the drug as an anesthetic for animals. Thieves rob veterinarians, then attempt to sell the drug. "Ketamine is already in the country because it is a drug that has medicinal value," Jackson County Assistant Prosecutor Wade Mutchler said.
    But Ketamine has a long way to go before it becomes a problem to the degree of ecstasy. Recent statistics from the U.S. Drug Enforcement Administration's Detroit office revealed an explosion of "club" drugs surfacing in Michigan last year. Those include ecstasy, GHB, Rohypnol and Ketamine, which can be used in combination with each other. Ecstasy, which produces stimulant and psychedelic effects, is often used at parties because it enables party-goers to dance or remain active for longer periods of time, according to the Office of National Drug Control Policy. Ketamine, also known as "Jet," is a depressant that produces a shorter-lasting hallucinatory effect. It causes the user to lose coordination and judgment.
    About 100,000 ecstasy tablets were seized in metropolitan Detroit with a street value of $2.5 million in 2000 while virtually none was seized the year before. About 80 percent of ecstasy is manufactured in Holland and eastern Europe. As for Jackson, Mutchler said the county has had an increase in ecstasy-related arrests but only a handful of Ketamine-related arrests in recent years. He said there have also been a few break-ins at veterinarian clinics, but most don't realize the drug is locked up. "But it is nothing compared to metro Detroit or other larger urban areas," Mutchler said.
    The most recent area contact with Ketamine was when state police broke up the theft-ring that is suspected of having several veterinarian clinics on its hit list. Troopers from the Jonesville post were conducting property inspections of Hillsdale County businesses last month and noticed a suspicious vehicle parked near an Allen business. They pulled the vehicle over and found burglary tools, two crowbars and some marijuana. Detective Sgt. William Kanouse said he feels he can link the suspect with several burglaries in the area, including some veterinary clinics. No charges in the burglaries have been filed yet, however. The investigation may result in six or seven more suspects responsible for 35 to 40 break-ins in Hillsdale, Lenawee, Jackson and Branch counties, as well as Ohio and Indiana, Kanouse said.
    Kanouse said investigators from all the police agencies in those locations are sharing information. "We are going to see if the methods of breaking in were similar," Kanouse said. He said there have only been one or two veterinarian office break-ins in Hillsdale County in the last year. "It's not like it has turned into an epidemic," Kanouse said. "But we have information that one of our burglary suspects is also a Ketamine user."
    Ketamine can be "cooked" from its liquid form to a powder that looks similar to cocaine. A typical dose weighs about 0.2 grams after it is baked from liquid form to crystallize, Mutchler said. Veterinarians buy the liquid at about $10 per bottle. Those bottles sell on the street for $80, said Lt. Cliff Edwards of the Jackson Narcotics Enforcement Team. It became a controlled substance in Michigan in August 1999. Controlled substances have five different levels of control, called "schedules." Ketamine is a Schedule III drug, meaning it has a medicinal purpose but has the possibility of being abused. Drugs that have very little medicinal value but have a high rate of abuse, like ecstasy, are Schedule I narcotics.
    Ketamine hydrochloride was first manufactured in the 1960s after being developed at the University of Michigan Hospital and promoted as a rapid-acting anesthetic for both animals and humans. But human use became problematic because high doses during surgery caused dream-like states in patients, Edwards said. It became popular in the '70s when some in the New Age crowd used it for meditative purposes, Edwards said. Drug guru Timothy Leary touted Ketamine as a tool for self-exploration. "It was supposedly used to talk to animals," Edwards said. There is irony, because the drug is a very popular anesthetic for animals. "We use a 50/50 mixture with diazepam," said Dr. Sheila Kirt of the Kibby Park Animal Hospital. "I think it's bizarre. I can't imagine why anyone would want this stuff and what would happen if they tried it."
    Kirt said Ketamine isn't the only anesthetic vets can use, but she uses it almost exclusively because she is familiar with it and feels it is a safer anesthetic than others, including barbiturates. She said Kibby Park was broken into at least a year ago, but nothing was taken. She said because Ketamine is a controlled substance, it must always be under lock and key. "It's the law," Kirt said. "It can never be just sitting out on a counter. We also have to keep close track of all of our shipments and orders."
    Dr. Dawn Sheffield of Gaide Veterinary Hospital said her peers are well aware of the demand for the drug. She said hopefully the community is aware of the danger involved with using it. "When taken as a full dose, this is a drug that is very dangerous," Sheffield said. At least 21 deaths nationally in 1999 were linked to Ketamine, according to the Office of Drug Control Policy.
    Edwards said a normal dose puts the user into "K Land," a mellow world that produces feelings of being transformed into a robot. "The voice becomes monotone and motions become stiff," Edwards said. Taking a larger dose is a called going into a "K Hole," he said. "Users feel like they are having an out-of-body experience," he said. "Users go into a dreamlike state, have hallucinations, become confused and lose coordination of their muscles."
    Being arrested for possession can have a sobering effect, however. Delivery or possession of Ketamine with intent to deliver is a 7-year felony with a maximum of a $10,000 fine. Possession is a two-year felony with a $2,000 fine and use of Ketamine is a one-year felony with a $1,000 fine. Mutchler said the "use" charge is not used as much as possession charges in most drug cases.  "It is really a lessor charge that can be used if no drug is found but paraphernalia is around or doctors detect it when doing blood samples," Mutchler said. "What we will really push for is seven years in prison."

Detox Docs on Trial for Malpractice Accuse State Officials of Bias
Linda A. Johnson, Associated Press- 6/5/2001

TRENTON, N.J.--Two physicians in the midst of a lengthy civil trial for malpractice have filed a motion asking the judge to order the director of New Jersey's Department of Consumer Affairs to appear in court so their attorneys can question him. The motion also accuses the director, Mark Herr, of engineering the charges against the doctors because of his personal bias against physicians who are recovering addicts, which Drs. Lance Gooberman and David Bradway are.
    The motion, filed late Monday with Administrative Law Judge Jeff Masin and sent to the prosecutor Tuesday, also asks Masin to order the prosecutor, Deputy Attorney General Douglas J. Harper, to turn over documents from his investigation that the defense attorneys believe have been withheld. ''They're giving us the stuff late, they're giving us the stuff redacted and they're not giving it all to us,'' Gooberman said in a telephone interview Tuesday evening. He said some of the documents were requested as long ago as two years. A spokesman for Herr did not immediately return a call seeking comment.
    Gooberman and Bradway, addiction specialists who offered a new procedure called rapid heroin detoxification in their Merchantville office, face the possible loss of their medical licenses because seven of the 2,300 patients who underwent the procedure over a four-year span later died. The doctors are charged with gross and repeated malpractice, negligence, incompetence and professional misconduct and have been barred from doing the procedure for now. The trial began in early January and has been continuing on several days each month.
    Rapid heroin detoxification involves using medications to rapidly flush drugs out of addicts' bodies and ease withdrawal symptoms such as diarrhea, cramps and tremors, all while patients are under anesthesia for several hours. Numerous U.S. doctors and many overseas also perform the procedure, but usually in a hospital with an overnight stay required. ''People are dying all over the place from heroin. I've got something that works. Why are they coming after me?'' Gooberman said. ''I've never done anything wrong.''   Both doctors, as well as experts who have testified on their behalf, insist Gooberman and Bradway followed established medical standards and were not responsible for the patients' deaths.
    The motion asks that Herr be ordered to appear in court when the trial resumes next week. It states that ''the spark that ignited these proceedings from their inception was an institutional bias, against members of the recovering drug-addicted community, that pervaded the New Jersey Department of Consumer Affairs.'' ''Mark Herr, as the director, has produced and influenced ... this bias in order to subject Drs. Gooberman and Bradway to disparate treatment,'' the motion reads. ''This sentiment is so widespread that the Medical Society of New Jersey ... recently filed suit against Mr. Herr, in his official capacity, claiming violations'' of the Americans with Disabilities Act and other federal laws in the department's handling of recovering physicians seeking to return to practice.  It also states that Harper has grossly misrepresented facts in the case and that one of the chief prosecution witnesses, New York addiction specialist Dr. Herbert Kleber, is biased, partly because he offered a competing medical procedure at a much higher price.

Rushing Off Antidepressants Can Bring More Distress
Judy Foreman, Boston Globe- 6/5/2001

At first, Zoloft seemed like ''manna from heaven,'' says this 53-year-old woman, a teacher who lives in Watertown. It was the summer of 1999 and, for reasons she still doesn't fully understand, she had slipped into a ''terrible slump.'' Her doctor suggested Zoloft, America's second most popular antidepressant, after Prozac. And for a while, it was great, says the woman, who does not want her name used. But after nearly a year on the drug, she developed a twitch in her left eyelid. It may not have been related to the Zoloft, but since she was feeling fine, she decided to stop taking the drug. And, unlike many people who quit antidepressants, she did it the right way: very slowly - cutting the dose little by little over six weeks. Even so, she wound up with three months of withdrawal hell, or discontinuation syndrome, the term psychiatrists prefer because withdrawal suggests that antidepressant drugs are addictive (like cocaine or heroin), which they are not.
    Discontinuation syndrome is not a recurrence of the original depression, though that can happen, too. It's a brand new set of problems, in this woman's case, bad headaches, vertigo, and dizziness. At one point during a walk, she says, ''my body felt like it was tipping to one side. I had to keep lying down. It was terrible.'' Could a drug that was no longer in her system somehow be causing weird symptoms she'd never had before? ''That was the thing that got me the most creeped out,'' she says. ''The drug clearly is out of your body. So what was it that lasted for three months?''
    What lasted so long for this teacher, and many others who stop taking antidepressant drugs, is what scientists now think of as a prolonged period of re-adjustment during which the chemistry of the brain settles into a kind of new, non-depressed normal. To be sure, many of the millions of people worldwide who take antidepressants experience no withdrawal symptoms when they stop. But some studies suggest that one in every 10 have some symptoms and one in 20 suffer significant distress, says Dr. Jerrold Rosenbaum, chief of psychiatry at Massachusetts General Hospital. Others, among them Dr. Andrew Leuchter, director of the division of adult psychiatry at the UCLA Medical Center, believe the actual figures are much higher.
    Yet even doctors who should be on the lookout for withdrawal symptoms - such as dizziness, increased nervousness, irritability, insomnia, and a dramatic increase in vivid dreams - often aren't paying close attention. A 1997 study in the Journal of Clinical Psychiatry showed that 70 percent of general practitioners and, surprisingly, a third of psychiatrists don't know that significant withdrawal symptoms can occur when people stop taking antidepressants called selective serotonin reuptake inhibitors, or SSRIs, including Prozac, Zoloft, Paxil, Luvox, Celexa, and a similar drug, Effexor. (Withdrawal syndromes can also occur with antidepressants that work differently from the SSRIs, including older drugs such as Elavil and Tofranil) ''It's an under-recognized problem,'' says Leuchter, because when people stop taking a drug and then develop new symptoms, they can't believe it has ''anything to do with the medicine because, if they're not taking it, how can it affect them?''
    But withdrawal clearly does happen, though researchers still aren't sure why. The basic thinking is that depression is caused by a deficiency of serotonin, a key neurotransmitter in the brain. SSRIs boost serotonin by stopping its re-absorption into brain cells, thus keeping more serotonin where it's needed, in the synapses, or gaps, between nerve cells. As the brain adapts to increased levels of serotonin, some neuroscientists think there is a decline in either the number or sensitivity of the brain's molecular gateways that can put serotonin to work. Then, when SSRIs are discontinued, withdrawal symptoms may occur as the nervous system, now primed for lots of serotonin, isn't getting enough, says Dr. Alexander Bodkin, chief of clinical psychopharmacology research at McLean Hospital in Belmont.
    One thing researchers are sure of is that the severity of withdrawal symptoms from SSRIs is closely correlated with how long the drug remains in the body. The longer the drug or its active metabolic breakdown products stay in the body, the less severe the withdrawal.  ''The faster-clearing the drug, the worse the withdrawal,'' says Dr. Michael Craig Miller, a psychiatrist who edits the Harvard Mental Health Letter.   Prozac is least likely to cause withdrawal because its metabolic breakdown products linger in the body for as long as five weeks. In fact, precisely because of this, one strategy for people who have trouble getting off other SSRIs is to switch to Prozac and then taper slowly off of that. By contrast, Paxil, Luvox, and Celexa may trigger withdrawal because they are faster-clearing, lingering in the body for just four to five days. Zoloft lingers slightly longer. Effexor, a variant of standard SSRIs, has the shortest half-life of all, about 5 hours, which means it is highly likely to cause withdrawal symptoms.
    Recent studies have bolstered the idea that faster-clearing drugs lead to worse withdrawal. In 1998, Rosenbaum of MGH and his team studied 220 patients and found that those who abruptly stopped taking Paxil, and to a lesser extent, Zoloft, had significant withdrawal symptoms, while those who stopped taking Prozac did not. Another study published last year in the British Journal of Psychiatry found essentially the same pattern. Yet another study, sponsored by Lilly Research Laboratories (Eli Lilly makes Prozac) and published last year in Psychoneuroendocrinology, showed that people who suddenly stopped taking Paxil had a significant increase in heart rate and stress hormone levels, while those taking Zoloft or Prozac did not.
    The bottom line is that if you want to wean yourself from antidepressants, do so slowly, by decreasing your dose by half every one to two weeks. It may take weeks or even months to discontinue completely, but that doesn't really matter. ''There's never a rush in getting off these medications,'' says Leuchter of UCLA. ''What's the hurry? If you have been on them for six to 12 months and you're tolerating them well, there's no point in going too quickly.'' And if you do develop withdrawal symptoms despite tapering off slowly, try going back to the previous dose, then switching to Prozac and weaning yourself from that. The most important lesson, says the teacher from Watertown, who is now symptom-free, is that antidepressants - despite the recent backlash in the media - significantly help millions of people. ''I would never say, `Don't go on it,''' she says. ''I would just say be very aware that when you want to get off it, go to a doctor who knows about this.''

Third Methadone Clinic Proposed for Portland Area
Associated Press, 6/6/2001

PORTLAND, Maine (AP) A third methadone clinic is being proposed in the Portland area in an effort to combat the growing number of heroin addicts in southern Maine. Discovery House, which dispenses methadone in South Portland, wants to open a clinic in the Bayside neighborhood of Portland.  Methadone is a synthetic narcotic that suppresses an addict's craving for drugs for as long as 24 hours. The city would have no role in reviewing or approving the clinic, other than ensuring it complies with zoning regulations. It's possible, however, that the City Council could amend the existing zoning, or enact a special ordinance, to prohibit such facilities in residential neighborhoods.
    Meanwhile, state substance abuse officials are also planning to build a methadone clinic in Portland, saying the state has seen an alarming rise in opiate use in the past few years. They also cited the growing number of people in Maine who are becoming addicted to OxyContin, a prescription painkiller used to treat cancer patients that can produce a high similar to heroin. The state envisions a full-service, nonprofit clinic that would include inpatient and outpatient programs, counseling services and a ''12-step'' aspect. In addition to the clinic in South Portland, there is a methadone clinic in Winslow. Another clinic is about to open at Acadia Hospital in Bangor and a clinic is being considered in Machias.
    Methadone is viewed by many experts as the most effective way to treat the growing population of people addicted to heroin and opium-based prescription painkillers. It has proven to be a viable treatment method for nearly 30 years.   Discovery House, which has been dispensing methadone since 1994, serves about 500 people.

Paxil Maker Ordered to Pay $8 Million
Associated Press, 6/7/2001

CHEYENNE, Wyo. — The manufacturer of the nation's second-best-selling anti-depressant must pay $8 million to the relatives of a man who killed himself and three others after taking the drug Paxil. Jurors in U.S. District Court considering the wrongful death civil suit returned a verdict against SmithKline Beecham today. They received the case Tuesday afternoon. Relatives of Donald Schell, 60, claim the man, originally from Gillette, Wyo., took two Paxil tablets before shooting his wife, their daughter, his granddaughter and himself to death on Feb. 13, 1998. The survivors' lead attorney, Andy Vickery, had asked the jury to award a total of $25 million in damages.
    Besides Schell, the victims were his wife, Rita Schell, 55; their daughter, Deborah Tobin, 31; and Alyssa Tobin, 9 months. Tobin's widower, Tim Tobin, and Donald Schell's sister, Neva Hardy, filed the wrongful-death lawsuit. Vickery also asked the jury to award damages to Michael Schell, the Schells' adult son, and to Rita Schell's mother. The jury awarded damages in varied amounts for each death, with the largest awards — $2.5 million each — for the deaths of Deborah and Alyssa Tobin going to Tim Tobin.
    In its findings, the jury concluded that Paxil could cause someone to commit suicide or homicide and that the drug was in fact a proximate cause of the deaths in this case. The jury attributed 80 percent of the fault in the case to the drug maker and 20 percent to Donald Schell. A call seeking comment from representatives of the drug company was not immediately returned today.
    In closing arguments, Vickery said Paxil can produce suicidal and homicidal reactions in a small number of people. "Since 1990, SmithKline Beecham knew there was a small group at risk and Don Schell was one of those vulnerable people," he said. The company, now GlaxoSmithKline PLC, failed to provide adequate label warnings about the possibility of violent reactions, nor did it adequately test for the risk of such reactions, he said.
    Attorneys for the company maintained that Paxil is a safe treatment for depression. "It's plain from the facts, science and common sense," Charles Preuss said in closing arguments. "Don Schell's escalating depression caused this. "The real tragedy is Paxil didn't have a chance to do its job and save lives," he said. "Paxil could have saved four lives in Gillette." Vickery said Schell told people he hallucinated when he took Prozac a decade earlier. Preuss said Schell went through five previous bouts of depression that kept him out of work, but Schell did not follow the recommendations of at least three psychiatrists. Also, he said, Schell had been coping with the death of his father-in-law and brother and had problems at work regarding a threatened lawsuit. Doctors from across the United States and from England were called to testify during the 2 ½-week trial. Central nervous system drugs like Paxil are GlaxoSmithKline's biggest product group. GlaxoSmithKline's world headquarters are in London and its U.S. research operations are based in Philadelphia.

Philip Morris Owes Ill Smoker $3 Billion, Jury Rules
Myron Levin and Dalondo Moultrie Los Angeles Times- 6/7/2001

LOS ANGELES - A jury yesterday ordered cigarette maker Philip Morris Inc. to pay more than $3 billion in damages to a cancer-stricken Marlboro smoker, in the tobacco's industry worst defeat at the hands of an individual plaintiff. It was also one of the largest jury awards in history. The jury made the award to Richard Boeken, 56, a resident of the Topanga area who suffers from lung cancer that has spread to his brain.
    After a trial that lasted more than two months, the Los Angeles Superior Court jury deliberated seven days before awarding Boeken, a Topanga area resident, nearly $5.54 million in compensatory and $3 billion in punitive damages. On votes ranging from 9-3 to 12-0, the jury found Philip Morris, the country's biggest cigarette maker, guilty on all eight of Boeken's claims, including negligence, misrepresentation, fraud, and selling a defective product.
    William S. Ohlemeyer, vice president and associate general counsel for Philip Morris, called the verdict ''outrageous'' and ''wildly out of line.'' ''For the jury to return a verdict in this case for Mr. Boeken ... they have to believe that he wasn't aware of the risks of smoking,'' Ohlemeyer said. He said Philip Morris will ask Judge Charles W. McCoy Jr. to set aside the verdict and will pursue an appeal if he does not.
    The verdict in the first smoking-and-health case ever tried in Los Angeles County was the fourth case lost on the West Coast by the once-invincible tobacco industry, including a pair of multimillion-dollar losses in San Francisco and another in Portland, Ore. Philip Morris shares swooned on news of the verdict in after-hours trading, falling to $48.25 from a regular-session close of $50 on the New York Stock Exchange. Big Tobacco's worst courtroom loss was a $144.8 billion punitive damages awarded last July in a giant Florida class action, which is now under appeal.
    But the Boeken verdict far exceeded any prior jury award to a single smoker and was one of the largest jury awards against any corporate defendant. ''We got to that figure [$3 billion] because we thought that figure would hurt them,'' said juror Ann Anderson, who works as a court clerk supervisor at the Superior Court's central civil west division, the building where the trial was held.   Juror Denise Key, a government worker from Los Angeles, said: ''We want them to be responsible for their product. ... We want them to put on their product: `It kills.'''
    Richard Daynard, head of the Tobacco Products Liability Project in Boston, said the verdict ''shows what happens when a jury tries to figure out how to punish companies that are responsible for killing hundreds of thousands of their customers each year.'' The verdict reflects the impact of the repeal of a longtime ban on product liability suits against cigarette makers. Three cases have been tried since the ban was abolished in September 1997, with plaintiffs winning all three.
    In 1999, a San Francisco jury ordered Philip Morris to pay lung cancer victim and former Marlboro smoker Patricia Henley $51.5 million, later reduced by the trial judge to $26.5 million. Last year, another San Francisco jury ordered Philip Morris and R.J. Reynolds Tobacco to pay $21.7 million in another lung cancer case.
    In March, shortly before the start of the Boeken trial, an industry representative who spoke on condition of anonymity conceded that the industry had not ''figured out how to win on the West Coast yet.'' But he joked that it had ''retained every social scientist west of the Mississippi to figure it out.'' Given the trend of industry losses in California, the focus will shift to the state Supreme Court, which has agreed to consider industry appeals of the two previous San Francisco verdicts. Cigarette makers are arguing, in part, that in light of the prior lawsuit ban, judges erred in admitting evidence of industry conduct prior to 1998. A ruling in favor of the industry could shut off the litigation for good.

At Trial, Rebirthing Tape Reveals Pain, Gentleness
Kieran Nicholson, Denver Post- 6/8/2001

As part of the "holding therapy" Candace Newmaker underwent last April, therapist Connell Watkins alternated between drill sergeant and doting caregiver to the 10-year-old girl. The therapy was intended to dispel any influence that Candace's biological mother might have had on the child; to get Candace to unconditionally obey her adoptive mother; and to break Candace of manipulative ways.  Watkins also hoped to get Candace to cough up secrets of alleged past abuse. A videotape of the "holding session," which began being shown Thursday, continued Friday for jurors in the Jefferson County trial of Watkins and Julie Ponder, two Evergreen therapists who treated Candace. Both are charged with reckless child abuse resulting in death. Candace suffocated while wrapped in a blanket during the rebirthing therapy.
    Sheriff's Detective Diane Obbema said that during the holding session, Watkins grabbed Candace's face 90 times, shook her head 309 times, shouted in the girl's face 69 times and threatened her 49 times. Watkins also stroked her face gently, talked to her in sweet tones and encouraged Candace to scream at her - in what amounted to an emotional roller coaster ride.
"Do you like your real mom to be boss to you?" Watkins says sternly.
"No," says the girl.
"She's still bossing you around though you haven't lived with her for four years," Watkins says. "We know she is still in your head and still bossing you."
Watkins says, "Is it fun being your birth mom?"
"No, I hate it," Candace replies.
Watkins instructs Candace to say, "I couldn't make her love me!"
"Louder!" screams Watkins.
"I couldn't make her love me!" screams Candace.
At one point Watkins tells Candace, "You act like a child who hates the world."
"We can change that if you want to," says Watkins. "But it's almost getting too late. Got it?"
"Got it!" the girl screams back.
Watkins then tries to get Candace to tell her about "secrets."
Candace says she doesn't want to tell because it could be "embarrassing."
"These are private matters, but you have to tell the people you love," Watkins says in a gentle voice.
"What is it she's (biological mother) afraid of that you're going to tell?" Watkins says.
"I don't know," replies Candace. "That she didn't love me?"
"We already know that," says Watkins.
Watkins then goes into a series of questions.
"Did she hurt you physically?"
"Not very much," Candace says.
"Did she feed you enough?"
"No, not enough."
"Did you see mom have sex with other men?"
"No."
Candace admits her biological mother beat her bare bottom with a belt, but only a few times.  The tape shows Candace hugging her adoptive mother, Jeane Newmaker, during a break. "Mommy, Mommy," she cries out, and they hug.  They sit face to face, holding hands, Newmaker telling Candace this could be their last shot at becoming a family.
"Is it hard to talk about Angie (Candace's biological mother)?" Newmaker says.
Candace nods yes, Newmaker begins to cry but Watkins comes into the room and scolds Candace for making her mother weep.  Later, Watkins tells Candace that she's going to get a haircut.
"How short?" says the girl.
Short, like a soldier's hair, Watkins replies. The haircut will be symbolic of change.
Candace climbs into a chair.  A woman named Denise folds the girl's long hair, which was more than halfway down her back, and begins to cut. The camera is turned off.
    The trial resumes Monday morning.

Vigil Set to Support Curbing Domestic Violence
Associated Press, 6/8/2001

AUGUSTA, Maine--Supporters of a bill aimed at fighting sexual assault and domestic violence are determined to let lawmakers know people support the initiative. A candlelight vigil was held on the State House steps Thursday evening as a way to prove that Mainers are committed to ending domestic violence. ''We urge every woman and man and family in the state who wants to end violence and to interrupt the cycle of abuse against women, to show their commitment,'' said Tracy Cooley of the Maine Coalition to End Domestic Violence. At least 100 activists gathered for the event. Lawmakers last month overwhelmingly approved the bill to improve access to direct services for victims.
    The bill would provide prevention programs in schools from kindergarten through high school and coordinated community programs among numerous public and nonprofit agencies to respond to and prevent domestic violence. It would also provide support for community-based agencies. The only question is how it will be paid for. The $4.8 million price tag is expected to be debated this week by the state Appropriations Committee.
    Similar legislation was passed 23 years ago with widespread support but failed to receive funding because lawmakers thought it didn't have public support, said Laura Fortman of the Maine Women's Lobby. ''The Maine Women's Lobby was founded to prevent that situation from happening again,'' she said. ''This time, we're here, we're watching and we're organizing.''
    Crime statistics released last month by the Public Safety Department showed domestic violence reports rose during the year 2000, despite an overall drop in the state's crime rate. The figures showed domestic violence assaults rose by 12.5 percent in 2000 after two years of decline. Police agencies received 4,468 reports of domestic violence assaults last year.

Domestic Partner Bill Clears California Assembly
Julie Tamaki, Los Angeles Times- 6/8/2001

SACRAMENTO--In an emotional debate that touched on religion, fairness and falling in love, the Assembly passed legislation Wednesday that would expand the rights of gays and lesbians in domestic partnerships. Assemblywoman Carole Migden, the San Francisco Democrat who helped pass a law two years ago that enabled gay and lesbian couples to register as domestic partners in California, moved a step closer to increasing their benefits as well as those of seniors who register as domestic partners. "This bill addresses the issue of fairness and justice for nontraditional families," Migden said. "It responds to a broad base of Californians who are choosing to define commitment differently, but still adhere to a set of social responsibilities."
    With a crucial hurdle passed in the Assembly, Migden said she is confident that her bill, which expands health, estate planning and unemployment benefits for domestic partners, will win both the Senate's approval and Gov. Gray Davis' signature. Davis, who vetoed a similar Migden measure last year, has not taken a position on the legislation. Lawmakers split along party lines on the bill, AB 25, which cleared the Assembly on a vote of 43 to 29 following more than an hour of intense debate.
    Assemblywoman Jackie Goldberg, a Los Angeles Democrat and one of three lesbians serving in the lower house, grew increasingly emotional as she recounted a past challenge she faced because of the California legal system. Partially sedated and about to undergo back surgery, Goldberg said, she was forced to scramble to find two witnesses and lawyer so that her partner would have power of attorney to make medical decisions on her behalf. "Why should I have to? None of you have to," Goldberg said. "You could be on your 14th marriage and you can get what I can't get after 22 years."
    Republicans objected to the measure, saying it violated the spirit of Proposition 22, the ballot initiative that state voters approved last year that defined marriage as a heterosexual-only bond. Assemblyman Jay La Suer (R-La Mesa) said the bill threatened to overturn the will of the majority of Californians. He also said he was glad he had a mother and a father because if he had had a mother and a mother or a father and a father he would not be here. "This bill is a steppingstone to undermine marriage in the state of California," added Assemblyman Dennis Mountjoy (R-Monrovia). Assemblyman Sam Aanestad (R-Grass Valley) opposed the measure on religious grounds. He told Migden he could not vote for the bill because according to his beliefs, homosexuality is an abomination. "For me personally it's about obedience," Aanestad said. "I don't have a choice."
    Assembly Democrats quickly lined up to rebuke their conservative counterparts. "This bill is not about God, the Bible or Proposition 22," said Assemblywoman Christine Kehoe (D-San Diego). "It's about fairness and equal rights for thousands of Californians."
Assemblyman Roderick Wright (D-Los Angeles) joined Republicans in reciting biblical phrases. Wright chose phrases, however, to bolster support for the measure. "One of the things Jesus said was love everyone as I have loved you," Wright said. Added Assemblyman Joe Simitian (D-Palo Alto): "Who are we . . . to say the love we feel for our husbands and wives is somehow superior to the love these women and men feel for each other?"
    In addition to allowing partners in same-sex couples to file wrongful-death suits, the measure would permit them to make medical decisions on behalf of sick partners and inherit their estates without wills. Supporters of the measure include Sharon Smith, the partner of Diane Whipple, the lacrosse coach mauled to death in a notorious dog attack. Smith lent her support to the bill during a March hearing in the Capitol after learning she had no right to sue on behalf of Whipple.
    But the bill also has been the focus of intense lobbying by opponents, including the Campaign for California Families. Democratic lawmakers complained about slick color fliers that were customized with their individual photographs and sought to pressure them into opposing the bill. They also reported being bombarded by phone calls urging them to vote against it. The Rev. Louis Sheldon, chairman of the Anaheim-based Traditional Values Coalition, warned that Migden's bill would burden California's mid-size and small businesses. "It's hard for them to absorb the additional costs for domestic partner benefits," he said.

Poll: Most Favor Efforts to Combat Addiction Over Punishment
Kate Miltner- ABC News- 6/8/2001

Americans by nearly a 3-1 margin prefer treatment programs instead of incarceration for first- and second-time drug offenders, a view that could signal support for efforts to revamp the nation's drug laws. Sixty-nine percent of adults in an ABCNEWS.com poll say they'd support a state law requiring drug treatment over jail time for first and second offenses. Twenty-five percent oppose it.
    A group led by financier George Soros has been backing this change, starting with Proposition 36, approved by California voters in November. It places first- or second-conviction nonviolent drug users in treatment programs instead of in jail. The Soros group plans similar campaigns in Ohio, Florida and Michigan next year.
    Men and Republicans are marginally less apt to favor treatment programs — they're preferred by 66 percent of men and 62 percent of Republicans, compared to 72 percent of women and 73 percent of Democrats and independents. Better-educated people also are slightly more apt to favor treatment instead of jail time. This ABCNEWS.com survey was conducted by telephone May 16-20 among a random national sample of 1,024 adults. The results have a three-point error margin. Sampling, data collection and tabulation was conducted by TNS Intersearch of Horsham, Pa.

Drug Spending, Fueled by Ailing Baby Boomers to Double
Linda A. Johnson, Associated Press- 6/8/2001

U.S. spending on prescription medications likely will double in the next five years, according to a forecast by Merck-Medco, the country's biggest manager of prescription drug plans. Just over half of the increase will be from increased spending on two categories of drugs: cardiovascular medicines, including those for controlling cholesterol and blood pressure; and central nervous system drugs, including those for pain, arthritis, and depression and other psychiatric disorders.
    A surprise in the report, which was released today, is that the expected trend is fueled not by senior citizens, but by Baby Boomers developing chronic health problems like heart disease and gastrointestinal disorders. "While it's definitely true that older people tend to have higher drug costs ..., the rate of growth in prescription drug spending is highest in people aged 40 to 55," said Glen Stettin, vice president of clinical products for Franklin Lakes, N.J.-based Merck-Medco, which handles prescription benefits for nearly one in four Americans. The company also determined that spending on prescriptions among Merck-Medco clients rose 14 percent last year.  The rate of increased spending was lowest in the 65 to 79 age group, but that group's average cost per member for prescription drugs was the highest, nearly $1,400 a year.
    Stettin expects spending to rise 15 percent to 20 percent a year for many of the prescription plans Merck-Medco administers. Unlike years ago, many patients with chronic conditions such as heart disease are taking multiple medicines, rather than just one or two, Stettin said Tuesday.  Another reason for increased spending is higher prices for some widely used drugs. "A lot of the newer drugs, they're brand-name drugs. They're protected by patent and they're more expensive," Stettin said. Some relief is in sight, however, according to Stettin: "In the next three to five years, there will be patent expirations for brand-name drugs representing $20 billion in annual sales."
    Generic drugs, which generally cost a third to a half as much as brand names, will soon be competing with those losing patent protection. Merck-Medco, a subsidiary of drug maker Merck & Co., administers plans for other health insurers, government agencies and major employers such as General Motors Corp. and the United Parcel Service. The company handles electronic payment and approvals for purchases at retail pharmacies for 65 million Americans. It also operates a mail order prescription business for those customers. The report did not disclose total spending on medications by all of Merck-Medco's customers.

Magellan Takes Over Management of Wayne County's Mental Health Programs
Sarah A. Webster, Detroit News- 6/7/2001

Magellan Behavioral Health Inc., which will take over the management of Wayne County's mental health programs, is no stranger to Michigan. Magellan already manages the care of about 3 million members here, through contracts with Blue Cross Blue Shield of Michigan, the State of Michigan Employees and Retirees, the United Auto Workers-Ford and several other health plans. The company has an office in Farmington Hills with 70 employees.
    In all, Magellan, based in Columbia, Md., manages 70 million members nationwide, making it the nation's largest managed behavioral health organization. The National Committee for Quality Assurance, which oversees the quality of managed care organizations, has accredited Magellan in 11 states, including Michigan. All but one of those accreditations was noted as having "excellent programs" that meet or exceed standards. Many health plans and self-insured employers have subcontracted the management of mental health services to companies such as Magellan, which has about 6,000 employees nationwide. But in recent years, Magellan has seen privatization of government mental health services as a potential area of growth.
    The public market hasn't been smooth sailing for Magellan, though. The company took major lumps in Montana, which in 1997 embarked on a statewide mental-health privatization effort. The largest such project in the nation at the time, it failed horribly. "I think the end results were close to tragic," said Montana Sen. Bob Keenan, who eventually brought the state's five-year, $400-million contract with Magellan to an end. Magellan did not pay bills due to mental health providers, such as hospitals and psychiatrists, creating animosity. Magellan, which lost $15.7 million the first year, quit before a state effort to cut its funding passed.
    Magellan's contract in Wayne County gives it $20 million over four years to make managerial and administrative decisions. However, all the risk will be assumed by the county, which will continue to pay the bills. Still, Keenan faults Magellan for poor communication, which could be an issue here. Keenan said Magellan was slow to bring problems to the Legislature's attention, even when it was clear the state was not paying the company enough money for the necessary services. "I can't blame Magellan for all of the problems. Their contract was insufficient to provide the services," Keenan said. Still, he noted, "It wasn't handled well by the management at Magellan." Magellan spokeswoman Erin Somers agreed there were problems in Montana, though she said Magellan has learned from its mistakes. She said the company inherited its contract with Montana when it acquired another company, Merit Behavioral Care, and it would not have signed onto that contract today.

Wayne County Cuts Programs for the Mentally Ill
Paul Egan, Detroit News- 6/9/2001

DETROIT -- Mental health agencies expect cuts to their budgets and the services they provide the mentally ill as Wayne County tries to erase a $6.3-million departmental budget deficit. The cuts by the Detroit-Wayne County Mental Health Agency would worsen an already dire situation for more than 35,000 county residents who need mental health services but don't have private insurance, advocates for the mentally ill said Wednesday. "It's scary," said Kristine Nitzel of Wayne, who leads a support group for people suffering from depression. "You'll see more people walking the streets ill and more people going without the services they need."
    Cuts to mental health affect the whole community because ill people who aren't treated start to act out, said Roberta Sanders, executive director of New Center Community Health Center in Detroit, which provides mental health services on behalf of the county agency. "Maybe they don't understand they shouldn't be sleeping on the park bench, or loitering or panhandling," she said.
    Meanwhile, the Wayne County Commission is today expected to approve a $20.3-million contract with Magellan Behavioral Health Inc. of Maryland to partly privatize county services to the mentally ill, despite misgivings expressed by both elected and appointed officials. Commissioners say they have little choice but to hire Magellan Behavioral Health Inc. because Wayne County faces a June 18 deadline to show it has the management skills to control costs under a state-ordered shift to competitive managed care.
    But as the commission deals with the four-year Magellan contract, this year's projected deficit has the attention of county officials. Dr. Altha Stewart, executive director of the county mental health agency, has been meeting officials from Wayne County Executive Edward H. McNamara's office to develop a plan to eliminate the deficit for the fiscal year that ends Sept. 30. "We have not ruled out an across-the-board reduction in global budget contracts," Chief Financial Officer Thomas Naughton said.

Services contracted
The Detroit-Wayne County Mental Health Agency, which serves the developmentally disabled and people with substance abuse problems in addition to the mentally ill, doesn't provide services directly. Instead, it contracts with about 80 outside agencies, most of which give treatment on an outpatient basis. Sanders said she's bracing for a financial cut to her center because that's how the county has dealt with projected deficits before. The last time was six or seven years ago, she said. "A cut will be pretty devastating," said Sanders, whose center serves about 2,500 chronically and persistently mentally ill patients, many of whom are former residents of mental hospitals closed by former Gov. Jim Blanchard and Gov. John Engler in the past 20 years as part of an effort to deinstitutionalize care for the mentally ill. "It's not going to happen without probably some staff layoffs," she said.
    Nitzel, the Wayne woman who leads a depression support group, said she fears cuts to agencies because many are already so backlogged that it's difficult for patients to get an appointment or arrange for needed prescription drugs. "One of the people in my group is supposed to see a therapist once a week, and since January he's only seen her twice," Nitzel said.
    Between 35,000 and 50,000 residents are getting treatment through the county agency at any given time, Stewart said. Marie E. Chapman, past president of the National Alliance for the Mentally Ill for the Dearborn area, said the system is not working. "The Wayne County Jail is our largest mental health ward," Chapman said. If cuts are made, "we'll probably have to hire two psychiatrists to give out medication at the jail, instead of one."
    Wayne County officials blamed state funding cuts for the deficit. About 90 percent of most mental health funding comes from the state through the state and federal governments, while the county pays the remaining 10 percent. The Wayne County Commission oversees the administration of the Detroit-Wayne County Mental Health Agency. But Geralyn Lasher, a spokeswoman for the Michigan Department of Community Health, said any cuts in funding to Wayne County this year were offset by increases. Mental health funding to Wayne County increased from $474.4 million in 1999 to $499.3 million in 2000 to $506.1 million in 2001, Lasher said.

County under pressure
The state has been pressuring the county to show it's ready to compete with the private sector to provide mental health services or risk losing the responsibility. County officials were warned of looming changes in the delivery of mental health services in 1996.
"I don't know why we didn't have better preparation," Commissioner Bernard Parker said. "It raises questions of what we've been doing for the last four years." Changes for Wayne and other county mental health agencies, which serve people without private insurance, started taking effect in 1998. That's when county agencies moved to managed care from the old fee-for-service set-up under which patients and doctors determined treatment and bills were paid as they came in. Under managed care, health plans help determine what care patients need in an effort to control costs. Sometimes they deny care they determine is not medically necessary or suggest lower-cost alternatives. Starting next year, the state will allow private companies to outbid any county agencies that haven't shown they're efficient enough to handle the job.

Agency under fire
Stewart, executive director of the Detroit-Wayne County Community Mental Health Agency since 1999, said the agency in 1997 submitted a plan to the state that outlined steps it would take to improve its operations and efficiency to prepare for competition. But the agency never carried through on the promises, she told a Wayne County committee meeting Tuesday. "As far as why none of the steps that needed to be taken were taken ... I really can't answer that question," Stewart said. "Most of those people are no longer with mental health or the county."
    Because the plan was never carried out, county officials said they have little option but to today approve a four-year contract with Magellan to administer access to county mental health services and handle the claims. That's despite reservations about whether the $5-million-a-year price is a fair one and the fact Magellan is not using a minority subcontractor, as the county prefers.
    In a March 26 letter to Stewart, state Deputy Director of Mental Health and Substance Abuse Services Jeff Patton set a June 18 deadline for the county to show it can provide the administrative services Magellan will be hired to perform. Magellan, which says it will hire about 40 employees, was selected after the county received proposals from six companies. Naughton said he thought Magellan's initial cost estimates were the lowest ones received from a qualified bidder, though exact contract prices were negotiated after Magellan was selected. Gregory Hicks, director of administration for the Wayne County Commission, expressed concern that Magellan would not provide financial details that would show how the contract price was determined. But he still recommended approval of the contract because he said the commission had little choice.

Conference to Examine the Business Case for Mental Health Care
Ascribe News Service, 6/9/2001

ATLANTA -- Studies have shown a link between employees with depressive symptoms and decreased job performance, but companies increasingly are scrutinizing their mental health care benefits. As a result, the mental health community must do more to show companies how a lack of mental health care coverage can impact their bottom line. Representatives from corporations and mental health professionals will gather at a two-day conference on June 19 and 20 in Atlanta convened by the American Psychiatric Association and The Carter Center to look at the link between quality mental health care and its impact on worker productivity, disability, absenteeism, employee turnover and the corporate bottom line. ''We need to learn more about the concerns business has about mental health problems in the workplace, and get a sense of what mental health clinicians can do to help business provide effective psychiatric care for employees,'' said Richard K. Harding, M.D., APA President. ''We also need to learn what additional research needs to be done to develop effective and appropriate mental health services.''
    Presenters at ''The Business of Mental Health Care'' will discuss the presence of mental disorders and substance abuse in the workplace, examine such problems as absenteeism, disability, and reduced productivity, review the obstacles to effective treatment, and look at successful corporate initiatives that are providing quality mental health care. Former First Lady Rosalynn Carter, who will speak at the conference, has long been interested in mental health coverage offered by private insurers. The Carter Center Mental Health Program has addressed this issue in national symposia, including two on mental health in health care reform and one on mental health and mental illness in the workplace. ''The mental health community and the business community have a common goal: healthy employees and healthy companies,'' Mrs. Carter said. ''This meeting will allow both these communities to develop concrete ways to achieve this goal.''
    Last month the American Journal of Psychiatry reported on a longitudinal study of 6,000 employees in three corporations that found absenteeism due to health problems was twice as high for employees with depressive symptoms, compared to those without depression. The study also revealed the likelihood of decreased performance on the job is seven times higher for depressed employees.  ''By focusing on some of the most vexing workplace mental health issues such as depression, we hope to provide concrete and useful information, tools and approaches that corporations can use in meeting the mental health needs of their employees,'' Dr. Harding said.
    The American Psychiatric Association is the national medical specialty society representing more than 38,000 physicians who specialize in the diagnosis, treatment, and prevention of mental illnesses and substance use disorders. The Carter Center was founded in 1982 by former U.S. President Jimmy Carter and Rosalynn Carter to promote peace and health worldwide. It is guided by a fundamental commitment to human rights and the alleviation of human suffering; it seeks to prevent and resolve conflicts, enhance freedom and democracy, and improve health. The Carter Center Mental Health Program advances mental health promotion, mental illness prevention, and early intervention in children and their families.

U.S. & Mexican Governors to Study Drug Trafficking as Health Issue
Julie Watson, Associated Press, 6/9/2001

TAMPICO, Mexico--Governors from both sides of the Mexico-U.S. border have agreed to study drug trafficking as a health issue and not a crime. On Friday, the last day of the 19th annual Border Governors Conference in the Gulf of Mexico port of Tampico, officials announced they would form a commission of scholars from the 10 U.S. and Mexican states along the border to study drug smuggling from a public health perspective. Mexican governors proposed the idea, which was praised by New Mexico Gov. Gary E. Johnson. The conference includes California, Arizona, New Mexico and Texas in the United States and Baja California, Chihuahua, Coahuila, Nuevo Leon, Sonora and Tamaulipas in Mexico. California Gov. Gray Davis dropped out at the last moment to deal with his state's energy crisis.
    Johnson, a two-term Republican, has become one of the United States' leading proponents of the legalization of drugs including marijuana, cocaine and heroin. A former drug user himself, he believes drug use is a health problem, not a crime, and is pushing for state legislation to that effect. He believes ending the prohibition on drugs would reduce violence, corruption and many other problems in the border region. Chihuahua Gov. Patricio Martinez said he would support legalization of certain drugs to dilute the power of criminal groups that benefit from the black market. ''This should be studied, analyzed and looked at to see what the people want and what are the effects from a different perspective that considers not only their prohibition but also in given time their approval for medicinal purposes or for rehabilitation or for other reasons,'' Martinez said. ''We need to study all aspects of drug use, especially marijuana.''

Lawsuit Divide: Public Split on Patients' Bill of Rights
Dalia Sussman, ABC News- 6/9/2001

As Congress moves closer to a debate on patients' rights, Americans are sharply divided on the issue. Forty-four percent of the public favors a law making it easier for patients in managed care to sue their health plan, an ABCNEWS/Washington Post poll finds. Slightly more, 49 percent, oppose such a law, saying it would increase the cost of health care too much.
    With the Democrats now in control of the Senate, Majority Leader Tom Daschle, D-S.D., has said the so-called Patients' Bill of Rights will move up on the agenda, second only to education. The bill would allow patients to sue health plans in federal or state court for up to $5 million in damages. President Bush favors a competing bill in the Senate that's more limited in its scope; it would permit lawsuits only in federal court and put a $500,000 cap on damages.
    Higher-income Americans are more likely than low-income people to support making it easier to sue; that may be because they don't have to worry as much about increased costs of health care. Better-educated Americans (who tend to have higher incomes) are also more apt to back the right to sue.
`Though Americans are split about evenly on the right to sue, they favor the Democrats in Congress over Bush to handle the issue, by a 15-point margin, 52 percent - 37 percent. Just four in 10 approve of Bush's work on patients' rights to date; as many disapprove.   At the same time, about two-thirds of Americans side with Bush and the Republican leadership on the issue of jurisdiction: Sixty-five percent say state governments, not the federal government, would do a better job regulating health plans. That reflects a long-running phenomenon of greater public trust in state and local government.
    This ABCNEWS/Washington Post poll was conducted by telephone May 31-June 3, among a random national sample of 1,004 adults. The results have a three-point error margin. Fieldwork by TNS Intersearch of Horsham, Pa.